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This article argues for an essentially political definition of empire with sovereignty at its core, which recognises that British assertions of sovereignty were multiple, mutually contradictory and thus, taken together, incoherent. Tracing the history of conflict between different archetypes of sovereign authority, we argue that imperial crises occurred when empire's different ideas were forced to speak to one another, during world war, for example. The emphasis here on sovereignty and incoherence contrasts with conceptions of the history of the British empire which assert to the contrary that empire was a coherent entity. Such coherence can, we argue, only be maintained by treating empire as a metaphor for broader conceptions of power and thus collapsing the history of empire into other totalising meta-concepts such as global capitalism or Western cultural dominance. Recognition of the incoherence of imperial sovereignty offers new, more nuanced, readings of central concerns in the literature such as imperial violence and the economics of empire.
The treatment and evacuation of people with lower limb fractures in austere environments presents unique challenges that assistive exoskeletal devices could address. In these dangerous situations, independent mobility for the injured can preserve their vital capabilities so that they can safely evacuate and minimize the need for additional personnel to help. This expert view article discusses how different exoskeleton archetypes could provide independent mobility while satisfying the requisite needs for portability, maintainability, durability, and adaptability to be available and useful within austere environments. The authors also discuss areas of development that would enable exoskeletons to operate more effectively in these scenarios as well as preserve the health of the injured limb so that definitive treatment after evacuation will produce better outcomes.
Young people with social disability and severe and complex mental health problems have poor outcomes, frequently struggling with treatment access and engagement. Outcomes may be improved by enhancing care and providing targeted psychological or psychosocial intervention.
Aims
We aimed to test the hypothesis that adding social recovery therapy (SRT) to enhanced standard care (ESC) would improve social recovery compared with ESC alone.
Method
A pragmatic, assessor-masked, randomised controlled trial (PRODIGY: ISRCTN47998710) was conducted in three UK centres. Participants (n = 270) were aged 16–25 years, with persistent social disability, defined as under 30 hours of structured activity per week, social impairment for at least 6 months and severe and complex mental health problems. Participants were randomised to ESC alone or SRT plus ESC. SRT was an individual psychosocial therapy delivered over 9 months. The primary outcome was time spent in structured activity 15 months post-randomisation.
Results
We randomised 132 participants to SRT plus ESC and 138 to ESC alone. Mean weekly hours in structured activity at 15 months increased by 11.1 h for SRT plus ESC (mean 22.4, s.d. = 21.4) and 16.6 h for ESC alone (mean 27.7, s.d. = 26.5). There was no significant difference between arms; treatment effect was −4.44 (95% CI −10.19 to 1.31, P = 0.13). Missingness was consistently greater in the ESC alone arm.
Conclusions
We found no evidence for the superiority of SRT as an adjunct to ESC. Participants in both arms made large, clinically significant improvements on all outcomes. When providing comprehensive evidence-based standard care, there are no additional gains by providing specialised SRT. Optimising standard care to ensure targeted delivery of existing interventions may further improve outcomes.
Representation and computation are the best tools we have for explaining intelligent behavior. In our program, we explore the space of representations present in the mind by constraining them to explain data at multiple levels of analysis, from behavioral patterns to neural activity. We argue that this integrated program assuages Brette's worries about the study of the neural code.
A novel CBT-based intervention, tailored for young people, was developed in response to concerns about traditional diagnostically based approaches. Psychology of Emotions workshops use a normative approach to emotional difficulty instead of a diagnostic framework.
Aims:
To evaluate the acceptability and efficacy of Psychology of Emotions workshops within an IAPT service for young people aged 16–25 years.
Method:
This was a mixed-methods study, evaluating routinely collected self-report measures of depression and anxiety, and qualitative feedback forms. The main outcomes were rates of attendance, change in symptom severity, and participant views of the intervention.
Results:
From January to September 2016, 595 young people were invited to attend the Psychology of Emotions workshops, of whom 350 (58.8%) attended at least one session. Young people who attended all six sessions (8.1%) experienced significant reductions in self-reported anxiety (d = .72) and depression (d = .58) and 35.5% were classified as recovered at completion. Those who attended at least two sessions (41.3%) reported smaller but significant improvements in anxiety (d = .42) and depression (d = .45); 22.0% were classified as recovered at the last session attended. Participants provided largely positive feedback about the intervention.
Conclusion:
Psychology of Emotions is a promising treatment option, delivered outside of a diagnostic framework, for young people with mild to moderate mental health difficulties seen within IAPT services. Better understanding reasons for non-attendance might enable the intervention to be made accessible to more young people.
This article discusses findings from the literature and our own research related to the experience of the diagnostic process in mental healthcare, primarily from the perspective of patients, and it focuses on the benefits of collaboration. A common finding throughout our research is that, if a diagnostic process is undertaken, the majority of patients want to be actively involved and feel valued in it. This helps ensure that they find the process and the resulting diagnosis to be meaningful, informative and useful. We believe that collaboration could also mitigate some of the reported negative unintended consequences of diagnosis, including feeling stigmatised, labelled and disempowered. Our work has led us to conceive of diagnosis as having two overarching elements: the diagnostic process and the resulting diagnostic label. This article focuses specifically on the diagnostic process; we do not consider here the debate surrounding the evidence base for the validity of psychiatric classification.
LEARNING OBJECTIVES
After reading this article you will be able to:
• understand patients' experiences of the diagnostic process
• achieve a shared and collaborative diagnostic process with patients
• reflect on potential barriers and facilitators to collaborative diagnosis in your own practice.
OBJECTIVES/SPECIFIC AIMS: A hallmark of progressive HIV-1 infection is the massive activation and depletion of the gut barrier protective CD4 T helper subsets (Th17 and Th22) in the intestinal mucosa. The loss of these cells is thought to contribute to microbial translocation and systemic immune activation that occurs during chronic infection. In addition to the loss of protective Th subsets, we previously showed that chronically HIV-1 infected individuals have an altered colonic mucosal microbiome, which is in part characterized by a lower relative abundance of bacteria that produce the short-chain fatty acid butyrate in conjunction with increased relative abundance of gram-negative pathobionts. This dysbiosis was linked to markers of mucosal and systemic immune activation in these individuals. Following up on these clinical observations, we sought to understand how a loss of butyrate might contribute to HIV-associated inflammation. Initial studies showed that the addition of butyrate to cultured lamina propria mononuclear cells (LPMC) resulted in decreased pathobiont-driven gut T cell activation, HIV-1 infection levels and production of IL-17 and IFNy. Since the gut barrier protective Th17 and Th22 subsets are preferentially infected and depleted, which is critical to HIV-1 pathogenesis, we wanted to determine the mechanism by which butyrate modulates activation of these important Th subsets in the gut. METHODS/STUDY POPULATION: Total LPMCs or purified LP CD4 T cells were isolated from human jejunal tissue (n=3–6), labeled with CFSE and cultured with TCR/CD28 beads to mimic APC driven T cell activation, with the addition of butyrate at physiologic doses(0–2 mM). Four days after culture, secreted cytokine(IL-17 and IFNy) levels were measured by ELISA. Cells were then short-term (4 hr) mitogenically stimulated (PMA/Ionomycin) in the presence of a golgi transport inhibitor. Total CD4 T cell activation (CD38+/HLA-DR+, CD25+), proliferation (CFSElow), and frequencies of intracellular cytokines were measured by multi-color flow cytometry. Paired t-tests were performed to determine statistical significance. RESULTS/ANTICIPATED RESULTS: Butyrate inhibited LP CD4 T cell activation (p=0.013) and proliferation (p=0.015) within total LPMCs stimulated with TCR/CD28 beads in a dose-dependent manner, with significant activity starting at 0.125 mM. Quantification of total secreted cytokines revealed that butyrate significantly decreased both IL-17 and IFNy production after 4 days of culture at 0.0625 mM and 0.25 mM of butyrate, respectively. Assays using purified LP CD4 T cells demonstrated that butyrate directly decreased LP CD4 T cell activation, proliferation and cytokine production in response to TCR/CD28 stimulation. Studies on specific T helper subsets revealed that butyrate inhibited proliferation of Th17 cells at lower concentrations (IC50:0.147 mM) compared with Th1 (IC50:0.229 mM) and Th22 (IC50:0.258 mM) and Th non-IL-22/IL-17/IFNy producing (IC50:2.14 mM) subsets. In addition, it appeared there was a paradoxical increase of HIV-1 infection levels at lower concentrations of butyrate (0.125 mM). DISCUSSION/SIGNIFICANCE OF IMPACT: The addition of butyrate to activated LP CD4 T cells decreases TCR-mediated activation in a dose-dependent manner, and butyrate acts directly on purified LP CD4 T cell populations independent of other cell populations. Butyrate differentially inhibited the proliferation of Th17, Th1, and Th22 subsets, with Th17 cells being the most sensitive to butyrate but increased the infection levels of all T helper subsets at low concentrations. Further studies are needed to determine the mechanism of butyrate’s actions on LP Th cells and the sensitivity of Th17 cells to the inhibitory effects of butyrate. These results could help direct targeted manipulation of the colonic microbiome of HIV-1 infected individuals to help resolve inflammation and limit the impact of the infection in the gut mucosa and systemically.
Formal communication skills training is the norm at UK medical schools, and evidence is mounting that it is effective in a number of domains, including patient satisfaction and shared decision-making, leading to improved treatment adherence. However, applying these models in mental health settings is challenging, despite the fact that positive therapeutic relationships and an ability to actively manage consultations are the cornerstone of psychiatric practice. Communication skills training is still too often regarded as better suited to physical health consultations than more complex psychiatric interviews. Here, it is considered why this might be, with reference to the one eligible randomised controlled trial identified in this systematic literature review.
DECLARATION OF INTEREST
J.W. has previously worked with Professor Papageorgiou at the University of East Anglia and has authored chapters in books that she has co-edited.
This article traces the way in which modern institutions emerged in one region of British-ruled India—the Godavari Delta of coastal Andhra—during the early nineteenth century. Rejecting recently popular cultural theories and the vague language of ‘multiple modernities’, it suggests that modernity can be defined as the practical effort to govern subjects perceived as strangers with abstract and general categories. But, arguing that our conception of modernity needs to be limited, the article suggests that modern institutions always rely on non-modern ways of life: the rule of law depends on ideas about individual honour; bureaucracy; on family connections and affective expressions of loyalty; and rational interests that are coordinated by archaic idioms of political leadership. The peculiarity of the history of modernity in imperial India was marked not by the limited or partial imposition of modern practices, but by the British regime's reluctance to accept the legitimacy of the very non-modern forms of power it relied on. Tracing this process in the Godavari Delta, the article shows how a regime with limited local resources asserted the monopolistic authority of its structures of government, but in doing so, corroded its own capacity to exercise power. Local institutions which had coordinated local productive resources were undermined, but alternative forms of local leadership were unable to emerge. The consequence was famine in the 1830s, and in the 1840s an effort to refound the imperial regime by imposing British power on the region's natural resources.
Field experiments were conducted across the north-central United States to determine the benefits of various weed control strategies in corn. Weed control, corn yield, and economic return increased when a preemergence (PRE) broad-spectrum herbicide was followed by (fb) postemergence (POST) herbicides. Weed control decisions based on field scouting after a PRE broad-spectrum herbicide application increased weed control and economic return. Application of a PRE grass herbicide fb a POST herbicide based on field scouting resulted in less control of velvetleaf and morningglory species, corn yield, and economic return compared with a PRE broad-spectrum herbicide application fb scouting. Cultivation after a PRE broad-spectrum herbicide application increased weed control and corn yield compared with the herbicide applied alone, but economic return was not increased. An early-postemergence herbicide application fb cultivation resulted in the highest level of broadleaf weed control, the highest corn yield, and the greatest economic return compared with all other strategies. Weed control based on scouting proved to be useful in reducing the effect of weed escapes on corn yield and increased economic return compared with PRE herbicide application alone. However, economic return was not greater than the PRE fb planned POST or total POST strategies.
Digital signal processing is one of many valuable tools for suppressing unwanted signals or inter-ference. Building hardware processing engines seems to be the way to best implement some classes of interference suppression but is, unfortunately, expensive and time-consuming, especially if several miti-gation techniques need to be compared. Simulations can be useful, but are not a substitute for real data. CSIRO’s Australia Telescope National Facility has recently commenced a ‘software radio telescope’ project designed to fill the gap between dedicated hardware processors and pure simulation. In this approach, real telescope data are recorded coherently, then processed offline. This paper summarises the current contents of a freely available database of base band recorded data that can be used to experiment with signal processing solutions. It includes data from the following systems: single dish, multi-feed receiver; single dish with reference antenna; and an array of six 22 m antennas with and without a reference antenna. Astronomical sources such as OH masers, pulsars and continuum sources subject to interfering signals were recorded. The interfering signals include signals from the US Global Positioning System (GPS) and its Russian equivalent (GLONASS), television, microwave links, a low-Earth-orbit satellite, various other transmitters, and signals leaking from local telescope systems with fast clocks. The data are available on compact disk, allowing use in general purpose computers or as input to laboratory hardware prototypes.
Peer review is central to political science. In this article we collect the ideas of journal editors in political science and several recent PhDs, who met as a panel at the 2011 American Political Science Association Annual Meeting to discuss the principles of the review process. This includes why reviewing is important to the development of one's own scholarship but also offers some nuts and bolts on reviewing.
The objective of this study was to evaluate associations between adverse outcomes in twin pregnancies and preterm prelabour rupture of membranes (PPROM). A chart review of 246 consecutive twin pregnancies with confirmed PPROM was conducted. Regression analysis (β [natural log of the odds ratio] and odds ratio [OR]) was performed to identify independent predictors. Two hundred and forty-six twin pregnancies, 492 liveborns, and 20 neonatal deaths. Mean (SD) PPROM gestational age (GA): 31.3 (3.8) wk; delivery GA: 32.0 (3.3) wk. PPROM < 30wk was associated with increased parity (OR: 2.66), and log (admission leukocyte count) (OR: 9.99). Shortened latency was associated with PPROM GA (β = −0.17) and chorioamnionitis (β = 0.95). Neonatal sepsis was predicted by lower delivery GA (OR: 2.04). Adverse perinatal outcomes were protected against by older GA at PPROM (OR 0.53) and shortened latency (OR 0.73). It was concluded that increased leukocytosis and parity implies an infectious aetiology in earlier PPROM. Increased risk for neonatal sepsis at earlier delivery GA is consistent with gestation-dependent fetal immunocompetence. Early PPROM and long latencies were associated with increased adverse perinatal outcomes.