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.
There are large between-country differences in measures of economic and noneconomic well-being. Many researchers view increasing the stock of human capital as the key to raising economic development, promoting democratization, and improving health, and hence improving overall societal well-being. The single most studied aspect of human capital concerns cognitive competence. Differences in population cognitive competence might explain these societal differences. Evidence suggests that education builds cognitive competence, and education and cognitive competence promote better social outcomes, in terms of both economic and noneconomic factors. However, measuring population cognitive competence for countries requires representative samples, culture-fair tests, equivalency in the relationship between test measures and other cognitive attributes, and comparability in testing situations. In most cases, none of this has been achieved.
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.
Under electrochemical cycling, stress intensification and relaxation within small volumes at the lithium/solid-state electrolyte (SSE) interface are thought to be critical factors contributing to mechanical failure of the SSE and subsequent short-circuiting of the device. Nanoindentation has been used to examine the diffusion-limited pressure lithium can support in the absence of active dislocation sources at high homologous temperatures. Based on the underlying physics of this deformation mechanism, a simple perturbation model coupling local current density, elastic stress, and diffusional creep relaxation is introduced. Combining this analysis with the indentation results, it is possible to describe a defect length scale which is too large for effective diffusional creep relaxation, but too small for efficient dislocation multiplication. In this instance, the properties of the SSE may become critical, and relevant indentation results of the SSE are described. The final outcome of the proposed analysis is a newly developed deformation mechanism map.
Hen’s eyes (Ardisia crenata Sims) is a shade-tolerant invasive shrub displacing native understory in forests of the Coastal Plain of the southeastern United States. Few studies have explored herbicide effectiveness on A. crenata, with foliar applications of triclopyr amine or triclopyr ester typically referenced as the standard treatments. This study evaluated efficacy of eight foliar herbicide treatments and a nontreated check at three locations at 12 mo after the first treatment (12MAT1) and 12 mo after the second treatment (12MAT2) on established (greater than 8-cm high) and seedling (less than 8-cm high) A. crenata. Treatments were four triclopyr formulations: amine, ester, choline, and acid (all at 4.04 kg ae ha−1); imazamox (1.12 and 2.24 kg ae ha−1); flumioxazin (0.43 kg ai ha−1); and triclopyr amine plus flumioxazin (4.04 + 0.43 kg ae ha−1). At 12MAT1, triclopyr ester, the high rate of imazamox, and triclopyr acid resulted in greater control of established A. crenata than any other herbicide (68%, 66%, and 64%, respectively). At 12MAT2, all herbicides except flumioxazin resulted in some control of A. crenata. Triclopyr ester, triclopyr acid, and the high rate of imazamox provided 95%, 93%, and 92% control, respectively. Triclopyr choline did not perform as well as the acid or ester formulations, and the tank mix of flumioxazin and triclopyr amine did not improve control over triclopyr amine alone. This study identified triclopyr acid and imazamox (2.24 kg ae ha−1) as new options for A. crenata control and indicated variation in the performance among the four triclopyr formulations.
Self-reported activity restriction is an established correlate of depression in dementia caregivers (dCGs). It is plausible that the daily distribution of objectively measured activity is also altered in dCGs with depression symptoms; if so, such activity characteristics could provide a passively measurable marker of depression or specific times to target preventive interventions. We therefore investigated how levels of activity throughout the day differed in dCGs with and without depression symptoms, then tested whether any such differences predicted changes in symptoms 6 months later.
Design, setting, participants, and measurements:
We examined 56 dCGs (mean age = 71, standard deviation (SD) = 6.7; 68% female) and used clustering to identify subgroups which had distinct depression symptom levels, leveraging baseline Center for Epidemiologic Studies of Depression Scale–Revised Edition and Patient Health Questionnaire-9 (PHQ-9) measures, as well as a PHQ-9 score from 6 months later. Using wrist activity (mean recording length = 12.9 days, minimum = 6 days), we calculated average hourly activity levels and then assessed when activity levels relate to depression symptoms and changes in symptoms 6 months later.
Clustering identified subgroups characterized by: (1) no/minimal symptoms (36%) and (2) depression symptoms (64%). After multiple comparison correction, the group of dCGs with depression symptoms was less active from 8 to 10 AM (Cohen’s d ≤ −0.9). These morning activity levels predicted the degree of symptom change on the PHQ-9 6 months later (per SD unit β = −0.8, 95% confidence interval: −1.6, −0.1, p = 0.03) independent of self-reported activity restriction and other key factors.
These novel findings suggest that morning activity may protect dCGs from depression symptoms. Future studies should test whether helping dCGs get active in the morning influences the other features of depression in this population (i.e. insomnia, intrusive thoughts, and perceived activity restriction).
In the 1990s criteria were developed to detect individuals at high and imminent risk of developing a psychotic disorder. These are known as the at risk mental state, ultra high risk or clinical high risk criteria. Individuals meeting these criteria are symptomatic and help-seeking. Services for such individuals are now found worldwide. Recently Psychological Medicine published two articles that criticise these services and suggest that they should be dismantled or restructured. One paper also provides recommendations on how ARMS services should be operate.
In this paper we draw on the existing literature in the field and present the perspective of some ARMS clinicians and researchers.
Many of the critics' arguments are refuted. Most of the recommendations included in the Moritz et al. paper are already occurring.
ARMS services provide management of current problems, treatment to reduce risk of onset of psychotic disorder and monitoring of mental state, including attenuated psychotic symptoms. These symptoms are associated with a range of poor outcomes. It is important to assess them and track their trajectory over time. A new approach to detection of ARMS individuals can be considered that harnesses broad youth mental health services, such as headspace in Australia, Jigsaw in Ireland and ACCESS Open Minds in Canada. Attention should also be paid to the physical health of ARMS individuals. Far from needing to be dismantled we feel that the ARMS approach has much to offer to improve the health of young people.
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.
Although the efficacy of endovascular thrombectomy (EVT) for acute ischemic stroke caused by intracranial anterior circulation large vessel occlusion (LVO) is proven, demonstration of local effectiveness is critical for health system planning and resource allocation because of the complexity and cost of this treatment.
Using our prospective registry, we identified all patients who underwent EVT for out-of-hospital LVO stroke from February 1, 2013 through January 31, 2017 (n = 44), and matched them 1:1 in a hierarchical fashion with control patients not treated with EVT based on age (±5 years), prehospital functional status, stroke syndrome, severity, and thrombolysis administration. Demographics, in-hospital mortality, discharge disposition from acute care, length of hospitalization, and functional status at discharge from acute care and at follow-up were compared between cases and controls.
For EVT-treated patients (median age 66, 50% women), the median onset-to-recanalization interval was 247 min, and successful recanalization was achieved in 30/44 (91%). Alteplase was administered in 75% of cases and 57% of controls (p = 0.07). In-hospital mortality was 11% among the cases and 36% in the control group (p = 0.006); this survival benefit persisted during follow-up (p = 0.014). More EVT patients were discharged home from acute care (50% vs. 18%, p = 0.002). Among survivors, there were nonsignificant trends in favor of EVT for median length of hospitalization (14 vs. 41 days, p = 0.11) and functional independence at follow-up (51% vs. 32%, p = 0.079).
EVT improved survival and decreased disability. This demonstration of single-center effectiveness may help facilitate expansion of EVT services in similar health-care jurisdictions.
Endovascular thrombectomy (EVT) is efficacious for ischemic stroke caused by proximal intracranial large-vessel occlusion involving the anterior cerebral circulation. However, evidence of its cost-effectiveness, especially in a real-world setting, is limited. We assessed whether EVT ± tissue plasminogen activator (tPA) was cost-effective when compared with standard care ± tPA at our center.
We identified patients treated with EVT ± tPA after the Endovascular treatment for Small Core and Anterior circulation Proximal occlusion with Emphasis on minimizing computed tomography to recanalization times trial from our prospective stroke registry from February 1, 2013 to January 31, 2017. Patients admitted before February 2013 and treated with standard care ± tPA constitute the controls. The sample size was 88. Cost-effectiveness was assessed using the net monetary benefit (NMB). Differences in average costs and quality-adjusted life years (QALYs) were estimated using the augmented inverse probability weighted estimator. We accounted for sampling and methodological uncertainty in sensitivity analyses.
Patients treated with EVT ± tPA had a net gain of 2.89 [95% confidence interval (CI): 0.93–4.99] QALYs at an additional cost of $22,200 (95% CI: −28,902–78,244) per patient compared with the standard care ± tPA group. The NMB was $122,300 (95% CI: −4777–253,133) with a 0.85 probability of being cost-effective. The expected savings to the healthcare system would amount to $321,334 per year.
EVT ± tPA had higher costs and higher QALYs compared with the control, and is likely to be cost-effective at a willingness-to-pay threshold of $50,000 per QALY.
The diet of most adults is low in fish and, therefore, provides limited quantities of the long-chain, omega-3 fatty acids (LCn-3FAs), eicosapentaenoic and docosahexaenoic acids (EPA, DHA). Since these compounds serve important roles in the brain, we sought to determine if healthy adults with low-LCn-3FA consumption would exhibit improvements in neuropsychological performance and parallel changes in brain morphology following repletion through fish oil supplementation.
In a randomized, controlled trial, 271 mid-life adults (30–54 years of age, 118 men, 153 women) consuming ⩽300 mg/day of LCn-3FAs received 18 weeks of supplementation with fish oil capsules (1400 mg/day of EPA and DHA) or matching placebo. All participants completed a neuropsychological test battery examining four cognitive domains: psychomotor speed, executive function, learning/episodic memory, and fluid intelligence. A subset of 122 underwent neuroimaging before and after supplementation to measure whole-brain and subcortical tissue volumes.
Capsule adherence was over 95%, participant blinding was verified, and red blood cell EPA and DHA levels increased as expected. Supplementation did not affect performance in any of the four cognitive domains. Exploratory analyses revealed that, compared to placebo, fish oil supplementation improved executive function in participants with low-baseline DHA levels. No changes were observed in any indicator of brain morphology.
In healthy mid-life adults reporting low-dietary intake, supplementation with LCn-3FAs in moderate dose for moderate duration did not affect neuropsychological performance or brain morphology. Whether salutary effects occur in individuals with particularly low-DHA exposure requires further study.
In the history of human evolution, reading and writing skills were developed about 5,400 years ago (Dehaene, 2009), which is fairly late in the context of the 350,000–150,000 years of history of human speech (Perreault & Mathew, 2012). In terms of ontogeny, the acquisition of reading also follows that of speech over the course of the child’s early years. Nonetheless, reading has become one of the most important cognitive functions for daily life and reading difficulties can severely limit an individual’s ability to thrive in the modern world (Calfee, 1982; Rawson, 1978). Across languages and cultures, approximately 5–20 percent of the population (depending on definitional criteria) is affected by developmental dyslexia (DD), a specific reading impairment presents in the absence of other cognitive impairments (S. E. Shaywitz & Shaywitz, 2003).
The identity as a person with disabilities is a prerequisite for claiming disability rights. In Nicaragua, however, the disability identity is particularly nuanced for persons wounded in the Sandinista Revolution or the subsequent civil war. The members of the Organization of Disabled Revolutionaries (ORD) are all ex-Sandinista soldiers who are proud of their service. For them, their disability symbolizes their sacrifice as protectors of the community in the name of solidaridad. They adamantly identify as “war wounded” rather than as “persons with disabilities.” As a result, they increasingly see the disability-rights movement as a threat to their war-hero status. The members of the Nicaraguan Association of the Disabled Resistance (ADRN), however, see disability rights and the disability identity as an important opportunity. As wounded ex-combatants who fought, and lost, on the opposing side of the civil war, they are stigmatized within Segovia for having fought as Contras. Their disabilities acquired from war remind community members of their past as “traitors,” and thus not deserving of rights. But, by using disability rights as a new identity frame, the ADRN is able to gain access to opportunities that in the past had been denied.
The organizational model for Disabled Persons' Organizations as rights advocates, which is embedded in the UN Convention on the Rights of Persons with Disabilities, reflects a larger global trend within the international community promoting rights advocacy as the only legitimate form of civic participation, regardless of the people represented, the issue being addressed, or local history or tradition. This singular script for civil society has its origins in Cold War politics in the West, where the promotion of a free civil society throughout the Global South was used as a tool for defeating authoritarian regimes in the non-West. This history can best be understood using new institutional theory from organizational sociology, which shows how fields are governed by specific norms. What new institutional theory often ignores, however, is that organizations often belong to two or more fields at once. Disabled Persons' Organizations in Nicaragua are part of the international disability-rights movement, but they are also part of local norms civil society. Nicaraguan solidaridad has structured local civil society since the Nicaraguan Revolution (1979), when the population mobilized through “mass” organizations to promote the “common good.” This legacy leaves local disability associations caught between two institutional fields.
The adoption of the UN Convention on the Rights of Persons with Disabilities (CRPD) in 2006 engendered a global social movement to promote disability rights around the world. A central aim of this movement has been to support Disabled Persons Organizations’ (DPOs) human-rights work. This focus on advocacy has now become a new organizational norm disseminated from international donors, networks, and NGOs to grassroots DPOs through training and small grants provided to DPOs in the Global South. In many places, however, local DPOs have resisted the changes this new norm implies, instead seeking to continue their traditional focus on addressing their members’ concrete needs through material support and services. In Segovia, Nicaragua, seven grassroots DPOs share an internationally funded grant for rights advocacy. They struggle, however, to use the money to address their local members needs while also keeping the international donor happy. This disconnect between international norms and local associations is the result of Nicaragua’s history of mobilizing people for the purposes of addressing basic needs and promoting community development. Since the 1979 Sandinista Revolution, local citizens, including disabled persons, have joined grassroots groups in solidaridad in coming together for mutual aid and social support.
One organization, the Association of the Blind, finds a way of blending the norms of the international disability-rights movement with the norm of solidaridad in local civil society. Their founder, who is fully aware of international disability NGOs’ attempts to change the practices of his disabled-persons’ organization, takes a nuanced approach that seeks to link disability rights to the continuation of the association’s history of self-help by providing education and employment services to persons with visual impairments. Using this blended approach, the association is able to generate new interest in a job training and placement services. But, they soon realize they need more resources to keep up with the demand from local employers for more persons with disabilities. The Association of the Blind then turns to international donors in the hope that they will see their program as advancing disability rights in a concrete, material way. This new proposal, however, is universally rejected as not conforming sufficiently with the international norm of DPOs maintaining a singular focus on advocating for disability rights.
Recent disability-studies scholarship has begun to critique the field as neo-colonial. Disability-studies theory and concepts are based on the disability experience in the West. Disabled Persons' Organizations were, and remain, extremely significant actors within the lives of persons with disabilities in North America, Western Europe, and other communities throughout the West. These organizations were organized for the purposes of advocating for the independence and individual rights of persons with disabilities who they represented. It is the promotion of this organizational model for DPOs around the world that has become the international disability-rights movements “civilizing mission.” When grassroots DPOs in the Global South prioritize mutual aid, social support, and services over rights advocacy, they are deemed “backwards” by international advocates. These attempts to remake all civil societies in the image of the West deny local diversity and silence voices. Therefore, there is need for a much more open and tolerant global disability movement that reflects the disability experience of everyone.
Los Pipitos, also known as the Association of Parents of Children with Disabilities, is one of Nicaragua’s most celebrated solidaridad organizations. In Segovia, the local Los Pipitos has become a symbol of what local civil society can do. The local chapter, which started out as a volunteer-run pre-school, now operates a large complex of services with a Youth Center for adolescents and youth with developmental disabilities as its centerpiece. This local civil-society initiative, however, is now out of step with international norms for promoting disability rights rather than providing rehabilitation and social support. Thus, the local chapter begins to face increasing pressure from the outside to close down the center and instead organize the youth and their parents in a campaign for disability rights. Eventually, the Youth Center is shut down by the national office and a new executive director is installed. But, after the new director fails to engender a rights-advocacy program, local parents organize against her and take the organization back. This results in a “back to basics” campaign where local parents decide to rededicate themselves to the values of solidaridad and leave disability rights advocacy behind.
Increasingly, international human-rights movements “manufacture civil society from the outside.” In 2008, a Danish disability-rights organization came to Segovia and established the Association of the Physically and Motorly Disabled (ADIFIM), for the purposes of advocating for disability rights. That same year, Handicap International (HI) also created a new organization in Segovia, the Organization of Women with Disabilities (ODIFOM), to promote women with disabilities’ rights. In both cases, the organizations generated great enthusiasm and garnered dozens of new members. After the first few years, however, both organizations’ membership began a steep decline. Persons with disabilities who had joined ADIFIM became frustrated with its narrow focus on legal advocacy and monitoring disability-rights violations. By 2012, ADIFM took the drastic step of striking old members from their books in order to be able to reach a quorum during meetings. ODIFOM closed down altogether when their members became tired of consciousness-raising activities and decided to join women’s economic cooperatives instead. Both of these cases show the continuing power of solidaridad to shape disabled persons expectations for DPOs that make it difficult for organizations that reflect international norms to survive.