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.
Culture has an enormous influence on military organizations and their success or failure in war. Cultural biases often result in unstated assumptions that have a deep impact on the making of strategy, operational planning, doctrinal creation, and the organization and training of armed forces. Except in unique circumstances culture grows slowly, embedding so deeply that members often act unconsciously according to its dictates. Of all the factors that are involved in military effectiveness, culture is perhaps the most important. Yet, it also remains the most difficult to describe and understand, because it entails so many external factors that impinge, warp, and distort its formation and continuities. The sixteen case studies in this volume examine the culture of armies, navies, and air forces from the Civil War to the Iraq War and how and why culture affected their performance in the ultimate arbitration of war.
The global population including Canada’s is aging, which demands planning for housing that will support older adults’ quality of life. This mixed-method study is the first Canadian study to examine the impact of cohousing on older adults’ quality of life and involved 23 participants. The older adults rated their quality of life very high, especially in the environmental, physical, and psychological domains of the World Health Organization Quality of Life (WHOQOL_BREF) survey; quality of life in the social domain was rated low, which was surprising in light of the focus group data findings. Four themes of “belonging in a community”, “life in the community”, “changes associated with aging,” and “aging in place” emerged from the qualitative data to explain factors that influence older adults’ quality of life. This research provides foundational, strong evidence that seniors’ cohousing is an innovative housing solution that can support older adults’ quality of life.
To determine the baseline individual characteristics that predicted symptom recovery and functional recovery at 10-years following the first episode of psychosis.
AESOP-10 is a 10-year follow up of an epidemiological, naturalistic population-based cohort of individuals recruited at the time of their first episode of psychosis in two areas in the UK (South East London and Nottingham). Detailed information on demographic, clinical, and social factors was examined to identify which factors predicted symptom and functional remission and recovery over 10-year follow-up. The study included 557 individuals with a first episode psychosis. The main study outcomes were symptom recovery and functional recovery at 10-year follow-up.
At 10 years, 46.2% (n = 140 of 303) of patients achieved symptom recovery and 40.9% (n = 117) achieved functional recovery. The strongest predictor of symptom recovery at 10 years was symptom remission at 12 weeks (adj OR 4.47; CI 2.60–7.67); followed by a diagnosis of depression with psychotic symptoms (adj OR 2.68; CI 1.02–7.05). Symptom remission at 12 weeks was also a strong predictor of functional recovery at 10 years (adj OR 2.75; CI 1.23–6.11), together with being from Nottingham study centre (adj OR 3.23; CI 1.25–8.30) and having a diagnosis of mania (adj OR 8.17; CI 1.61–41.42).
Symptom remission at 12 weeks is an important predictor of both symptom and functional recovery at 10 years, with implications for illness management. The concepts of clinical and functional recovery overlap but should be considered separately.
Item 9 of the Patient Health Questionnaire-9 (PHQ-9) queries about thoughts of death and self-harm, but not suicidality. Although it is sometimes used to assess suicide risk, most positive responses are not associated with suicidality. The PHQ-8, which omits Item 9, is thus increasingly used in research. We assessed equivalency of total score correlations and the diagnostic accuracy to detect major depression of the PHQ-8 and PHQ-9.
We conducted an individual patient data meta-analysis. We fit bivariate random-effects models to assess diagnostic accuracy.
16 742 participants (2097 major depression cases) from 54 studies were included. The correlation between PHQ-8 and PHQ-9 scores was 0.996 (95% confidence interval 0.996 to 0.996). The standard cutoff score of 10 for the PHQ-9 maximized sensitivity + specificity for the PHQ-8 among studies that used a semi-structured diagnostic interview reference standard (N = 27). At cutoff 10, the PHQ-8 was less sensitive by 0.02 (−0.06 to 0.00) and more specific by 0.01 (0.00 to 0.01) among those studies (N = 27), with similar results for studies that used other types of interviews (N = 27). For all 54 primary studies combined, across all cutoffs, the PHQ-8 was less sensitive than the PHQ-9 by 0.00 to 0.05 (0.03 at cutoff 10), and specificity was within 0.01 for all cutoffs (0.00 to 0.01).
PHQ-8 and PHQ-9 total scores were similar. Sensitivity may be minimally reduced with the PHQ-8, but specificity is similar.
Both India and Nepal are prone to a wide range of natural and man-made disasters. Almost 85% of India’s area is vulnerable to one or more hazards, and more than 80% of the total population of Nepal is at risk of natural hazards. In terms of the number of people affected in reported disastrous events, India is in the top 10 and Nepal is in the top 20 globally. Over the last two decades, India and Nepal have taken steps to establish their respective National Disaster Management organizations, which provide essential disaster responses. However, key gaps still remain in trained clinical capacity for managing impacts from various disasters. Our review of the region has shown that large parts of the population suffer injuries, diseases, disabilities, psychosocial, and other health-related problems from disasters.
Develop disaster medicine clinical capacity to reduce morbidities and mortalities from disasters.
Independent published data and work undertaken by the lead author in various disasters in India and Nepal since 1993 formed the basis of establishing the Faculty of Disaster Medicine for South Asia. The Faculty of Disaster Medicine - India and Nepal (FDMIN) was launched from Pune in March 2015. This initiative is supported by the National Association of Primary Care (UK), Public Health England, Faculty of Pre-hospital Care of Royal College of Surgeons - Edinburgh and CRIMEDIM (Novara) - Italy.
FDMIN has international expert advisors and has outlined 16 modules training curriculum for health care professionals. FDMIN currently has partnerships for teaching disaster medicine program with 3 medical universities and 12 major health care providers. Six pilot training programmes have been conducted in Pune, Delhi, Chennai, and Kochin. Work is underway to submit an application to the Indian regulatory bodies for approval to establish a post-graduate diploma and Master’s for Disaster Medicine.
Historians have devoted much attention over the past forty years to the revolution in communication following the emergence of printing by movable type in midfifteenth- century Europe. Current scholarship questions whether such a revolution took place, and stresses the coexistence of manuscript and print, the intersection of both media with speech and pictures, and the partialness and gradualness of changes in communication between the fifteenth and eighteenth centuries. In parallel with these general debates, histories of generation have documented the increasing interest of learned men in the workings of women's bodies, and argued that knowledge of generation, even when shared only between women, could be instrumental in upholding the institution of marriage.
This chapter explores what happens when we consider the direct relevance of debates about script and print to understandings of human generation. It focuses on the fortunes of a kind of practical knowledge that is best identified by the medieval Latin term ‘experimenta’ (singular ‘experimentum’). Here is an example: if you wish to influence whether you will have a boy or a girl, you should use the herb mercury. It grows in two kinds, male and female, each effective in producing the corresponding kind of children,
so that the decoction of juice of the Male drank four dayes from the first day of purgation, will give force to the womb to procreate a male Child: but the juice of the Female drank for so many dayes, and in the same manner, will cause a female to be born, especially if the man lye with his wife when the [menstrual] Terms are newly over.
This instruction was first printed in 1559 in the Dutch physician Levinus Lemnius's Occulta naturae miracula (Secret miracles of nature), a compendium of wondrous phenomena and herbal knowledge proving the presence of God in the workings of nature. Widely translated throughout Europe, it came out in English in 1658. In chapters 3 to 11, Lemnius collected material about generation, beginning with the injunction to remember that procreation was a divine gift, and including information about resemblance, pregnant women's cravings, the roles of female seed and menstrual blood, and the sex of the child.
Experimenta were useful practical techniques for healing, influencing natural processes and foreseeing outcomes; that they had passed the test of experience was their chief recommendation.
Neuropsychological investigations can help untangle the aetiological and phenomenological heterogeneity of schizophrenia but have scarcely been employed in the context of treatment-resistant (TR) schizophrenia. No population-based study has examined neuropsychological function in the first-episode of TR psychosis.
We report baseline neuropsychological findings from a longitudinal, population-based study of first-episode psychosis, which followed up cases from index admission to 10 years. At the 10-year follow up patients were classified as treatment responsive or TR after reconstructing their entire case histories. Of 145 cases with neuropsychological data at baseline, 113 were classified as treatment responsive, and 32 as TR at the 10-year follow-up.
Compared with 257 community controls, both case groups showed baseline deficits in three composite neuropsychological scores, derived from principal component analysis: verbal intelligence and fluency, visuospatial ability and executive function, and verbal memory and learning (p values⩽0.001). Compared with treatment responders, TR cases showed deficits in verbal intelligence and fluency, both in the extended psychosis sample (t = −2.32; p = 0.022) and in the schizophrenia diagnostic subgroup (t = −2.49; p = 0.017). Similar relative deficits in the TR cases emerged in sub-/sensitivity analyses excluding patients with delayed-onset treatment resistance (p values<0.01–0.001) and those born outside the UK (p values<0.05).
Verbal intelligence and fluency are impaired in patients with TR psychosis compared with those who respond to treatment. This differential is already detectable – at a group level – at the first illness episode, supporting the conceptualisation of TR psychosis as a severe, pathogenically distinct variant, embedded in aberrant neurodevelopmental processes.
The value of the nosological distinction between non-affective and affective psychosis has frequently been challenged. We aimed to investigate the transdiagnostic dimensional structure and associated characteristics of psychopathology at First Episode Psychosis (FEP). Regardless of diagnostic categories, we expected that positive symptoms occurred more frequently in ethnic minority groups and in more densely populated environments, and that negative symptoms were associated with indices of neurodevelopmental impairment.
This study included 2182 FEP individuals recruited across six countries, as part of the EUropean network of national schizophrenia networks studying Gene–Environment Interactions (EU-GEI) study. Symptom ratings were analysed using multidimensional item response modelling in Mplus to estimate five theory-based models of psychosis. We used multiple regression models to examine demographic and context factors associated with symptom dimensions.
A bifactor model, composed of one general factor and five specific dimensions of positive, negative, disorganization, manic and depressive symptoms, best-represented associations among ratings of psychotic symptoms. Positive symptoms were more common in ethnic minority groups. Urbanicity was associated with a higher score on the general factor. Men presented with more negative and less depressive symptoms than women. Early age-at-first-contact with psychiatric services was associated with higher scores on negative, disorganized, and manic symptom dimensions.
Our results suggest that the bifactor model of psychopathology holds across diagnostic categories of non-affective and affective psychosis at FEP, and demographic and context determinants map onto general and specific symptom dimensions. These findings have implications for tailoring symptom-specific treatments and inform research into the mood-psychosis spectrum.
Different diagnostic interviews are used as reference standards for major depression classification in research. Semi-structured interviews involve clinical judgement, whereas fully structured interviews are completely scripted. The Mini International Neuropsychiatric Interview (MINI), a brief fully structured interview, is also sometimes used. It is not known whether interview method is associated with probability of major depression classification.
To evaluate the association between interview method and odds of major depression classification, controlling for depressive symptom scores and participant characteristics.
Data collected for an individual participant data meta-analysis of Patient Health Questionnaire-9 (PHQ-9) diagnostic accuracy were analysed and binomial generalised linear mixed models were fit.
A total of 17 158 participants (2287 with major depression) from 57 primary studies were analysed. Among fully structured interviews, odds of major depression were higher for the MINI compared with the Composite International Diagnostic Interview (CIDI) (odds ratio (OR) = 2.10; 95% CI = 1.15–3.87). Compared with semi-structured interviews, fully structured interviews (MINI excluded) were non-significantly more likely to classify participants with low-level depressive symptoms (PHQ-9 scores ≤6) as having major depression (OR = 3.13; 95% CI = 0.98–10.00), similarly likely for moderate-level symptoms (PHQ-9 scores 7–15) (OR = 0.96; 95% CI = 0.56–1.66) and significantly less likely for high-level symptoms (PHQ-9 scores ≥16) (OR = 0.50; 95% CI = 0.26–0.97).
The MINI may identify more people as depressed than the CIDI, and semi-structured and fully structured interviews may not be interchangeable methods, but these results should be replicated.
Declaration of interest
Drs Jetté and Patten declare that they received a grant, outside the submitted work, from the Hotchkiss Brain Institute, which was jointly funded by the Institute and Pfizer. Pfizer was the original sponsor of the development of the PHQ-9, which is now in the public domain. Dr Chan is a steering committee member or consultant of Astra Zeneca, Bayer, Lilly, MSD and Pfizer. She has received sponsorships and honorarium for giving lectures and providing consultancy and her affiliated institution has received research grants from these companies. Dr Hegerl declares that within the past 3 years, he was an advisory board member for Lundbeck, Servier and Otsuka Pharma; a consultant for Bayer Pharma; and a speaker for Medice Arzneimittel, Novartis, and Roche Pharma, all outside the submitted work. Dr Inagaki declares that he has received grants from Novartis Pharma, lecture fees from Pfizer, Mochida, Shionogi, Sumitomo Dainippon Pharma, Daiichi-Sankyo, Meiji Seika and Takeda, and royalties from Nippon Hyoron Sha, Nanzando, Seiwa Shoten, Igaku-shoin and Technomics, all outside of the submitted work. Dr Yamada reports personal fees from Meiji Seika Pharma Co., Ltd., MSD K.K., Asahi Kasei Pharma Corporation, Seishin Shobo, Seiwa Shoten Co., Ltd., Igaku-shoin Ltd., Chugai Igakusha and Sentan Igakusha, all outside the submitted work. All other authors declare no competing interests. No funder had any role in the design and conduct of the study; collection, management, analysis and interpretation of the data; preparation, review or approval of the manuscript; and decision to submit the manuscript for publication.
Bakaninbreen is a polythermal glacier in southern Spitsbergen, Svalbard, which surged between 1985 and 1995. For 9 days in spring 1987, when the surge front was travelling at ∼2.5-3.0 m d–1, three single-component geophones and two accelerometers were deployed in a T-shaped array immediately downstream of the surge front to record seismic emissions. The events were characterized by their waveforms and spectral content. At least three different categories have been identified: impulsive P- and S-waveforms, surface P- and S-wave trains, and harmonic (75-130 Hz) events. We interpret the impulsive events to originate at the base of the glacier, at or downstream of the surge front; the surface P- and S-wave trains from near-surface brittle fracture associated with the surface expression of the surge front itself; and the harmonic events from deep sources that involve resonance in a water-filled fracture, associated with the base of the surge front. We believe the basal events are related to the activation of stagnant ice downstream of the surge front, which allows water to access the bed and provides the mechanism for its propagation.
This paper presents the changes in the thermal structure of the polythermal glacier Storglaciären, northern Sweden, over the 20 year period 1989-2009 derived by comparing maps of the depth of the englacial transition between cold ice (permanently frozen) and temperate ice (which contains water inclusions). The maps are based on interpreted ice-penetrating radar surveys from 1989, 2001 and 2009.
Complex thinning of the cold layer, first identified between 1989 and 2001, is still ongoing. A volume calculation shows that Storglaciären has lost one-third of its cold surface layer volume in 20 years, with a mean thinning rate of 0.80 ± 0.24 m a-1. We suggest that the thinning of the cold layer at Storglaciären is connected to the climatic warming experienced by sub-Arctic Scandinavia since the 1980s and we argue that repeated ice-penetrating radar surveys over the ablation area of polythermal glaciers offer a useful proxy for evaluating glacier responses to changes in climate.
The incidence of psychotic disorders is elevated in some minority ethnic populations. However, we know little about the outcome of psychoses in these populations.
To investigate patterns and determinants of long-term course and outcome of psychoses by ethnic group following a first episode.
ÆSOP-10 is a 10-year follow-up of an ethnically diverse cohort of 532 individuals with first-episode psychosis identified in the UK. Information was collected, at baseline, on clinical presentation and neurodevelopmental and social factors and, at follow-up, on course and outcome.
There was evidence that, compared with White British, Black Caribbean patients experienced worse clinical, social and service use outcomes and Black African patients experienced worse social and service use outcomes. There was evidence that baseline social disadvantage contributed to these disparities.
These findings suggest ethnic disparities in the incidence of psychoses extend, for some groups, to worse outcomes in multiple domains.
We show that geophysical methods offer an effective means of quantifying snow thickness and density. Opportunistic (efficient but non-optimized) seismic refraction and ground-penetrating radar (GPR) surveys were performed on Storglaciären, Sweden, co-located with a snow pit that shows the snowpack to be 1.73 m thick, with density increasing from ∼120 to ∼500 kg m–3 (with a +50 kg m–3 anomaly between 0.73 and 0.83 m depth). Depths estimated for two detectable GPR reflectors, 0.76 ±0.02 and 1.71 ± 0.03 m, correlate extremely well with ground-truth observations. Refraction seismic predicts an interface at 1.90 ± 0.31 m depth, with a refraction velocity (3730 ± 190 ms–1) indicative of underlying glacier ice. For density estimates, several standard velocity-density relationships are trialled. In the best case, GPR delivers an excellent density estimate for the upper snow layer (observed = 321 ± 74 kg m–3, estimated = 319 ± 10 kgm–3) but overestimates the density of the lower layer by 20%. Refraction seismic delivers a bulk density of 404 ±22 kgm–3 compared with a ground-truth average of 356 ± 22 kg m–3. We suggest that geophysical surveys are an effective complement to mass-balance measurements (particularly for controlling estimates of snow thickness between pits) but should always be validated against ground-truth observations.
We have investigated the speed of compressional waves in a polythermal glacier by, first, predicting them from a simple three-phase (ice, air, water) model derived from a published ground-penetrating radar study, and then comparing them with field data from four orthogonally orientated walkaway vertical seismic profiles (VSPs) acquired in an 80 m deep borehole drilled in the ablation area of Storglaciären, northern Sweden. The model predicts that the P-wave speed increases gradually with depth from 3700ms–1 at the surface to 3760ms–1 at 80m depth, and this change is almost wholly caused by a reduction in air content from 3% at the surface to <0.5% at depth. Changes in P-wave speed due to water content variations are small (<10 ms–1); the model’s seismic cold–temperate transition surface (CTS) is characterized by a 0.3% decrease downwards in P-wave speed (about ten times smaller than the radar CTS). This lack of sensitivity, and the small contrast at the CTS, makes seismically derived water content estimation very challenging. Nevertheless, for down-going direct-wave first arrivals for zero- and near-offset VSP shots, we find that the model-predicted travel times and field observations agree to within 0.2 ms, i.e. less than the observational uncertainties.
Ground-penetrating radar has been widely used to map the thermal structure of polythermal glaciers. Hitherto, the cold–temperate transition surface (CTS) in radargrams has been identified by a labour-intensive and subjective manual picking method. We introduce a new automatic approach for picking the CTS that uses the difference in signal power exhibited by the cold and temperate ice layers. We compare our automatically computed CTS depths with manual picks. Our results show very good agreement between the two methods in most areas (r2 > 0.7). RMSEs computed at each trace in two-way travel-time from three test sites range from 14 to 19ns (2.4–3.2 m). The proposed automated method mostly fails in areas showing a rather gradual transition in signal power at the CTS. In some areas, high power originating from non-water sources is misinterpreted by the automatic picking method as ‘temperate ice’.
A considerable body of evidence suggests that early caregiving may affect the short-term functioning and longer term development of the hypothalamic–pituitary–adrenocortical axis. Despite this, most research to date has been cross-sectional in nature or restricted to relatively short-term longitudinal follow-ups. More important, there is a paucity of research on the role of caregiving in low- and middle-income countries, where the protective effects of high-quality care in buffering the child's developing stress regulation systems may be crucial. In this paper, we report findings from a longitudinal study (N = 232) conducted in an impoverished periurban settlement in Cape Town, South Africa. We measured caregiving sensitivity and security of attachment in infancy and followed children up at age 13 years, when we conducted assessments of hypothalamus–pituitary–adrenocortical axis reactivity, as indexed by salivary cortisol during the Trier Social Stress Test. The findings indicated that insecure attachment was predictive of reduced cortisol responses to social stress, particularly in boys, and that attachment status moderated the impact of contextual adversity on stress responses: secure children in highly adverse circumstances did not show the blunted cortisol response shown by their insecure counterparts. Some evidence was found that sensitivity of care in infancy was also associated with cortisol reactivity, but in this case, insensitivity was associated with heightened cortisol reactivity, and only for girls. The discussion focuses on the potentially important role of caregiving in the long-term calibration of the stress system and the need to better understand the social and biological mechanisms shaping the stress response across development in low- and middle-income countries.
The incidence of type 2 diabetes mellitus (T2DM) is increasing worldwide, including in developing countries, particularly in South Asia. Intakes of foods generating a high postprandial glucose (PPG) response have been positively associated with T2DM. As part of efforts to identify effective and feasible strategies to reduce the glycaemic impact of carbohydrate-rich staples, we previously found that addition of guar gum (GG) and chickpea flour (CPF) to wheat flour could significantly reduce the PPG response to flatbread products. On the basis of the results of an exploratory study with Caucasian subjects, we have now tested the effect of additions of specific combinations of CPF with low doses of GG to a flatbread flour mix for their impacts on PPG and postprandial insulin (PPI) responses in a South-Asian population. In a randomised, placebo-controlled full-cross-over design, fifty-six healthy Indian adults consumed flatbreads made with a commercial flatbread mix (100 % wheat flour) with no further additions (control) or incorporating 15 % CPF in combination with 2, 3 or 4 % GG. The flatbreads with CPF and 3 or 4 % GG significantly reduced PPG (both ≥15 % reduction in positive incremental AUC, P<0·01) and PPI (both ≥28 % reduction in total AUC, P<0·0001) compared with flatbreads made from control flour. These results confirm the efficacy and feasibility of the addition of CPF with GG to flatbread flour mixes to achieve significant reductions in both PPG and PPI in Indian subjects.
High-quality cost estimates for hospital-acquired Clostridium difficile infection (CDI) are vital evidence for healthcare policy and decision-making.
To evaluate the costs attributable to hospital-acquired CDI from the healthcare payer perspective.
We conducted a population-based propensity-score matched cohort study of incident hospitalized subjects diagnosed with CDI (those with the International Statistical Classification of Diseases and Related Health Problems, 10th Revision, Canada code A04.7) from January 1, 2003, through December 31, 2010, in Ontario, Canada. Infected subjects were matched to uninfected subjects (those without the code A04.7) on age, sex, comorbidities, geography, and other variables, and followed up through December 31, 2011. We stratified results by elective and nonelective admissions. The main study outcomes were up-to-3-year costs, which were evaluated in 2014 Canadian dollars.
We identified 28,308 infected subjects (mean annual incidence, 27.9 per 100,000 population, 3.3 per 1,000 admissions), with a mean age of 71.5 years (range, 0–107 years), 54.0% female, and 8.0% elective admissions. For elective admission subjects, cumulative mean attributable 1-, 2-, and 3-year costs adjusted for survival (undiscounted) were $32,151 (95% CI, $28,192–$36,005), $34,843 ($29,298–$40,027), and $37,171 ($30,364–$43,415), respectively. For nonelective admission subjects, the corresponding costs were $21,909 ($21,221–$22,609), $26,074 ($25,180–$27,014), and $29,944 ($28,873–$31,086), respectively.
Hospital-acquired CDI is associated with substantial healthcare costs. To the best of our knowledge, this study is the first CDI costing study to present longitudinal costs. New strategies may be warranted to mitigate this costly infectious disease.