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.
Any adequate normative theoretical account, or philosophy, of civil rights and liberties must accommodate, among other norms, those set out in the French Declaration of the Rights of Man and the Citizen (1789), the US Bill of Rights (1791), and the first twenty-one Articles of the Universal Declaration on Human Rights (1948). Paradigm cases include rights to life, physical integrity, security, privacy, property, and a fair trial; and freedoms of religion, expression, movement, contract, and association or assembly.
Engagement of frontline staff, along with senior leadership, in competition-style healthcare-associated infection reduction efforts, combined with electronic clinical decision support tools, appeared to reduce antibiotic regimen initiations for urinary tract infections (P = .01). Mean monthly standardized infection and device utilization ratios also decreased (P < .003 and P < .0001, respectively).
Archaeologists have struggled to combine remotely sensed datasets with preexisting information for landscape-level analyses. In the American Southeast, for example, analyses of lidar data using automated feature extraction algorithms have led to the identification of over 40 potential new pre-European-contact Native American shell ring deposits in Beaufort County, South Carolina. Such datasets are vital for understanding settlement distributions, yet a comprehensive assessment requires remotely sensed and previously surveyed archaeological data. Here, we use legacy data and airborne lidar-derived information to conduct a series of point pattern analyses using spatial models that we designed to assess the factors that best explain the location of shell rings. The results reveal that ring deposit locations are highly clustered and best explained through a combination of environmental conditions such as distance to water and elevation as well as social factors.
Little is known about the determinants of community integration (i.e. recovery) for individuals with a history of homelessness, yet such information is essential to develop targeted interventions.
We recruited homeless Veterans with a history of psychotic disorders and evaluated four domains of correlates of community integration: perception, non-social cognition, social cognition, and motivation. Baseline assessments occurred after participants were engaged in supported housing services but before they received housing, and again after 12 months. Ninety-five homeless Veterans with a history of psychosis were assessed at baseline and 53 returned after 12 months. We examined both cross-sectional and longitudinal relationships with 12-month community integration.
The strongest longitudinal association was between a baseline motivational measure and social integration at 12 months. We also observed cross-sectional associations at baseline between motivational measures and community integration, including social, work, and independent living. Cross-lagged panel analyses did not suggest causal associations for the motivational measures. Correlations with perception and non-social cognition were weak. One social cognition measure showed a significant longitudinal correlation with independent living at 12 months that was significant for cross-lagged analysis, consistent with a causal relationship and potential treatment target.
The relatively selective associations for motivational measures differ from what is typically seen in psychosis, in which all domains are associated with community integration. These findings are presented along with a partner paper (Study 2) to compare findings from this study to an independent sample without a history of psychotic disorders to evaluate the consistency in findings regarding community integration across projects.
Vomiting is common in children after minor head injury. In previous research, isolated vomiting was not a significant predictor of intracranial injury after minor head injury; however, the significance of recurrent vomiting is unclear. This study aimed to determine the value of recurrent vomiting in predicting intracranial injury after pediatric minor head injury.
This secondary analysis of the CATCH2 prospective multicenter cohort study included participants (0–16 years) who presented to a pediatric emergency department (ED) within 24 hours of a minor head injury. ED physicians completed standardized clinical assessments. Recurrent vomiting was defined as ≥ four episodes. Intracranial injury was defined as acute intracranial injury on computed tomography scan. Predictors were examined using chi-squared tests and logistic regression models.
A total of 855 (21.1%) of the 4,054 CATCH2 participants had recurrent vomiting, 197 (4.9%) had intracranial injury, and 23 (0.6%) required neurosurgical intervention. Children with recurrent vomiting were significantly more likely to have intracranial injury (odds ratio [OR], 2.3; 95% confidence interval [CI], 1.7–3.1), and require neurosurgical intervention (OR, 3.5; 95% CI, 1.5–7.9). Recurrent vomiting remained a significant predictor of intracranial injury (OR, 2.8; 95% CI, 1.9–3.9) when controlling for other CATCH2 criteria. The probability of intracranial injury increased with number of vomiting episodes, especially when accompanied by other high-risk factors, including signs of a skull fracture, or irritability and Glasgow Coma Scale score < 15 at 2 hours postinjury. Timing of first vomiting episode, and age were not significant predictors.
Recurrent vomiting (≥ four episodes) was a significant risk factor for intracranial injury in children after minor head injury. The probability of intracranial injury increased with the number of vomiting episodes and if accompanied by other high-risk factors, such as signs of a skull fracture or altered level of consciousness.
The main objective of this paper is to give an overview of the risks seen in the exploration and production of geothermal energy from the viewpoint of the regulator. The risks are categorised as conventional risks, ultra-deep risks and enhancing factors. These risks are similar to those seen in the oil and gas industry, but the maturity of the geothermal sector in terms of managing such risks is much lower.
Another objective of this paper is to discuss how these risks are managed and mitigated by the sector and the supervisor, State Supervision of Mines (SodM). Portfolio operators developing multiple projects, using skilled employees and embracing continuous improvement are seen as the way forward for the sector to grow safely and sustainably.
This paper concludes that positive developments have started, but a lot of work still needs to be done to ensure safe growth of the geothermal energy sector.
In an initial study (Study 1), we found that motivation predicted community integration (i.e. functional recovery) 12 months after receiving housing in formerly homeless Veterans with a psychotic disorder. The current study examined whether the same pattern would be found in a broader, more clinically diverse, homeless Veteran sample without psychosis.
We examined four categories of variables as potential predictors of community integration in non-psychotic Veterans: perception, non-social cognition, social cognition, and motivation at baseline (after participants were engaged in a permanent supported housing program but before receiving housing) and a 12-month follow-up. A total of 82 Veterans had a baseline assessment and 41 returned for testing after 12 months.
The strongest longitudinal association was between an interview-based measure of motivation (the motivation and pleasure subscale from the Clinical Assessment Interview for Negative Symptoms) at baseline and measures of social integration at 12 months. In addition, cross-lagged panel analyses were consistent with a causal influence of general psychiatric symptoms at baseline driving social integration at 12 months, and reduced expressiveness at baseline driving independent living at 12 months, but there were no significant causal associations with measures of motivation.
The findings from this study complement and reinforce those in Veterans with psychosis. Across these two studies, our findings suggest that motivational factors are associated at baseline and at 12 months and are particularly important for understanding and improving community integration in recently-housed Veterans across psychiatric diagnoses.
Classical stewardship efforts have targeted immunocompetent patients; however, appropriate use of antimicrobials in the immunocompromised host has become a target of interest. Cytomegalovirus (CMV) infection is one of the most common and significant complications after solid-organ transplant (SOT). The treatment of CMV requires a dual approach of antiviral drug therapy and reduction of immunosuppression for optimal outcomes. This dual approach to CMV management increases complexity and requires individualization of therapy to balance antiviral efficacy with the risk of allograft rejection. In this review, we focus on the development and implementation of CMV stewardship initiatives, as a component of antimicrobial stewardship in the immunocompromised host, to optimize the management of prevention and treatment of CMV in SOT recipients. These initiatives have the potential not only to improve judicious use of antivirals and prevent resistance but also to improve patient and graft survival given the interconnection between CMV infection and allograft function.
The otoliths (ear stones) of fishes are commonly used to describe the age and growth of marine and freshwater fishes. These non-skeletal structures are fortuitous in their utility by being composed of mostly inorganic carbonate that is inert through the life of the fish. This conserved record functions like an environmental chronometer and bomb-produced radiocarbon (14C)—a 14C signal created by atmospheric testing of thermonuclear devices—can be used as a time-specific marker in validating fish age. However, complications from the hydrogeology of nearshore marine environments can complicate 14C levels, as was the case with gray snapper (Lutjanus griseus) along the Gulf of Mexico coast of Florida. Radiocarbon of these nearshore waters is influenced by freshwater input from the karst topography of the Upper Floridan Aquifer—estuarine waters that are 14C-depleted from surface and groundwater inputs. Some gray snapper likely recruited to this kind of environment where 14C levels were depleted in the earliest otolith growth, although age was validated for individuals that were not exposed to 14C-depleted waters to an age of at least 25 years with support for a 30-year lifespan.
We study the extended Stefan problem which includes constitutional supercooling for the solidification of a binary alloy in a finite spherical domain. We perform an asymptotic analysis in the limits of large Lewis number and small Stefan number which allows us to identify a number of spatio-temporal regimes signifying distinct behaviours in the solidification process, resulting in an intricate boundary layer structure. Our results generalise those present in the literature by considering all time regimes for the Stefan problem while also accounting for impurities and constitutional supercooling. These results also generalise recent work on the extended Stefan problem for finite planar domains to spherical domains, and we shall highlight key differences in the asymptotic solutions and the underlying boundary layer structure which result from this change in geometry. We compare our asymptotic solutions with both numerical simulations and real experimental data arising from the casting of molten metallurgical grade silicon through the water granulation process, with our analysis highlighting the role played by supercooling in the solidification of binary alloys appearing in such applications.
Disinhibition and irritability, defined as loss of behavioral and emotional control, are frequent in the elderly. The working hypothesis for this study was that these disorders are associated with a cognitive alteration of control processes that manifests as non-routine behavior because of the dysfunction of a general executive component known as the supervisory attentional system (SAS).
A total of 28 elderly subjects with mild cognitive impairment were recruited and divided into two groups using the Neuropsychiatric Inventory. Fourteen subjects were allocated to the disinhibited group and 14 subjects matched for age, sex and educational level formed a disinhibition-free control group. The neuropsychological battery included the following tests: Mini Mental Score Evaluation, Boston Naming test, Token test, Trail Making and Verbal Fluency. Two tasks were specifically designed to stress the SAS: 1) A specific verbal sentence arrangement task in which subjects had to use sequential reasoning with verbal material. Each test sequence consisted of a series of words shown in jumbled order. The construction of some sequences had to be done by using familiar routine associations (valid conditions). In contrast, other sequences required the overriding selection of familiar routine associations, which were inappropriate within the general context of the task (invalid conditions). 2) Using the Continuous Performance Test, four aspects were evaluated: sustained, selective, preparation and suppressive attention.
The only group differences in neuropsychological test results were the following: 1) the sentence arrangement task. In comparison with the control group, the disinhibited group was impaired in invalid conditions and the calculated difference between the number of correct responses in invalid conditions minus that in valid conditions was significantly higher; and 2) the CPT. Disinhibited subjects had a significantly lower number of hits, exclusively in the ‘suppressive attention’ paradigm.
These results suggest that subjects with disinhibition have impaired supervisory system function.
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.
Clear scientific recommendations based on the best evidence available are essential in making decisions using all areas of applied science, including conservation. Unfortunately, ecological systems are enormously variable at all scales, and this variability drives uncertainty in predictions and recommendations. In this chapter different sources of variability are reviewed. It is crucial that sources of uncertainty are understood and tackled where possible. Ignoring uncertainty potentially leads to overconfident estimates of effectiveness, or biased outcomes if uncertainty is non-randomly distributed. Examples are given, and techniques for dealing with uncertainty are discussed, including new statistical and analytical techniques that can deal with uncertainties resulting from, for example, lack of information or missing data. The value of collating data across multiple sites or studies is also highlighted, and examples given of how this can help overcome the limitations of lack of information.
5-methoxypsoralen (5-MOP) stimulates pineal melatonin secretion, and a decrease in dark phase melatonin levels has been described in major depression. As exogenous melatonin has shown synchronizer properties, authors hypothesized that giving 5-MOP would have antidepressant properties.
Twenty-six inpatients meeting the criteria of major depressive disorders were enrolled in a four-week, double blind trial of 5-MOP versus amitriptyline. Clinical improvement was identical in both treatment groups but biological changes were different in each group: 5-MOP patients showed an early nocturnal surge of melatonin levels that was maintained at the fourth treatment week, while melatonin levels remained unchanged in patients treated with amitriptyline.
The aim of this study was to investigate relationships and differences between 2 scales assessing subject’s adaptative functioning. On the one hand, Axis V in the revised version of the Third Edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM III-R) includes specific symptoms for each level of functioning described. On the other hand, the Psychosocial Aptitude Rating Scale (PARS) does not include clinical symptoms. A total of 78 psychiatric inpatients were rated independently with the 2 scales. The 2 ratings were correlated for the whole sample and for each diagnostic category. Diagnosis (Axis 1) explained 63.9% of the variance in the Global Assessment Functioning (GAF) Scale (Axis V) and only 23.8% in the Psychosocial Aptitude Rating Scale (PARS). Axis V is then made redundant by Axis 1 which is contrary to the aim of a multi-axial system. PARS describes aspects of the disorder that are distinct from clinical symptoms. These occupational and social aspects may be of great interest for a better overall evaluation of severity of mental disorders.
Adjustment disorder with anxiety (AjD-A) is a common cause of severe anxiety symptoms, but little is known about its prevalence in old age.
This cross-sectional study examined the prevalence of AjD-A in outpatients over the age of 60 who consecutively consulted 34 general practitioners and 22 psychiatrists during a 2-week period. The diagnosis of AjD-A was obtained using the optional module for diagnostic of adjustment disorder of the Mini International Neuropsychiatric Interview (MINI). The study procedure also explored comorbid psychiatric conditions and documented recent past stressful life events, as well as social disability and current pharmacological and non-pharmacological management.
Overall, 3651 consecutive subjects were screened (2937 in primary care and 714 in mental health care). The prevalence rate of AjD-A was 3.7% (n = 136). Up to 39% (n = 53) of AjD-A subjects had a comorbid psychiatric condition, mostly of the anxious type. The most frequently stressful life event reported to be associated with the onset of AjD-A was personal illness or health problem (29%). More than 50% of the AjD-A patients were markedly to extremely disabled by their symptoms. Compared to patients who consulted psychiatrists, patients who were seen by primary care physicians were older, had obtained lower scores at the Hamilton Anxiety Rating Scale, benefited less frequently from non-pharmacological management and received benzodiazepines more frequently.
AjD-A appears to be a significantly disabling cause of anxiety symptoms in community dwelling elderly persons, in particular those presenting personal health related problems. Improvement of early diagnosis and non-pharmacological management of AjD-A would contribute to limit risks of benzodiazepine overuse, particularly in primary care settings.
Les objets technologiques, dont les nouvelles technologies de l’information et de la communication (nTIC), ainsi que les jeux vidéo dits « sérieux » (serious games) envahissent notre quotidien depuis quelques années. Leur utilisation dans les disciplines médicales est actuellement en développement croissant, notamment dans le domaine des neurosciences et du vieillissement. L’objectif de ce symposium est de présenter, en premier lieu, les recommandations scientifiques actuelles sur l’utilisation des nTIC et des serious games dans la prise en charge du sujet âgé et des atteintes neuropsychiatriques pouvant être associées. Ensuite, seront présentées les méthodes, utilisant les nTIC et les serious games, permettant d’améliorer l’évaluation et le dépistage des troubles cognitifs et des symptômes thymiques et comportementaux, ainsi que les stratégies non pharmacologiques, utilisant ces outils technologiques, permettant la stimulation des performances cognitives et la prise en charge des perturbations thymiques.
Avec le vieillissement de la population, la maladie d’Alzheimer et les pathologies associées représentent un défi majeur de santé publique. Parallèlement, les nouvelles technologies de l’information et de la communication prennent une part de plus en plus importante dans notre vie quotidienne et peuvent être un support tant pour l’évaluation que pour une aide directe des usagers. Les serious games sont des applications informatiques, dont l’intention est de combiner, avec cohérence, à la fois des aspects sérieux (Serious) comme l’enseignement, l’apprentissage, la communication, la rééducation, avec des ressorts ludiques issus du jeu vidéo (Game). Dans le cadre du projet AZ@GAME  lauréat AAP e-santé no 1 des Investissements d’Avenir, des jeux sont en cours de développement avec pour objectif de stimuler les capacités cognitives et physiques du patient. Un des problèmes rencontrés concerne l’engagement des sujets à comprendre puis à pratiquer ces jeux. En effet, engagement et motivation diminuent quand le patient rencontre des problèmes d’utilisation. Nous présentons ici un système d’assistance automatisé basé sur la technologie Kinect. Trois groupes de patients (Plaintes mnésique : n = 10 ; âge moyen, 76,6 ; MCI : n = 10 âge moyen, 77,9 ; et maladie d’Alzheimer : n = 10 ; âge moyen, 79,9) ont participés à une séance d’entraînement utilisant un jeu pour stimuler l’attention concentration. Le jeu était proposé avec ou sans l’aide du système. Les résultats indiquent que tous les groupes ont eu de meilleures performances (score et temps de jeu) avec l’aide du système. Ce résultat est tout particulièrement important dans le groupe de patients Alzheimer (score > de 31 % et temps de réalisation < de 10 % avec le système). Compte tenu de ces résultats la prochaine étape aura pour objectif de proposer un système encore plus motivant à une population plus importante de patients.
Depression is present in 35% of adolescents who commit suicide. It is crucial that we identify which of these depressed adolescents are at greatest suicide risk. Suicide attempts are strongly associated with suicide risk, and therefore commonly used as a proxy measure. Non-suicidal self-injury (NSSI) is often seen as being less serious than suicide attempts.
To determine which clinical and psychosocial factors in depressed adolescents at baseline predict both suicide attempts and non-suicidal self-injury over 28 weeks follow-up.
Adolescents with major depressive disorder (n = 164) taking part in the Adolescent Depression Antidepressants and Psychotherapy Trial were evaluated. Clinical symptoms, family and friendship functioning, suicide attempts and non-suicidal self-injury were recorded at baseline.
Suicidal and non-suicidal self-harm were measured during 28 weeks follow-up.
High suicidality, non-suicidal self-injury and poor family function at entry were significant independent predictors of suicide attempts occurring over 28 weeks follow-up. NSSI was the strongest predictor of suicide attempts (adjusted OR = 3.2, p = 0.006). NSSI over follow-up was independently predicted by non-suicidal self-injury (adjusted OR = 20, p < 0.0005), increased hopelessness, anxiety disorder, and being younger and female at entry.