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Electroconvulsive therapy (ECT) is recommended in treatment guidelines as an efficacious therapy for treatment-resistant depression. However, it has been associated with loss of autobiographical memory and short-term reduction in new learning.
To provide clinically useful guidelines to aid clinicians in informing patients regarding the cognitive side-effects of ECT and in monitoring these during a course of ECT, using complex data.
A Committee of clinical and academic experts from Australia and New Zealand met to the discuss the key issues pertaining to ECT and cognitive side-effects. Evidence regarding cognitive side-effects was reviewed, as was the limited evidence regarding how to monitor them. Both issues were supplemented by the clinical experience of the authors.
Meta-analyses suggest that new learning is impaired immediately following ECT but that group mean scores return at least to baseline by 14 days after ECT. Other cognitive functions are generally unaffected. However, the finding of a mean score that is not reduced from baseline cannot be taken to indicate that impairment, particularly of new learning, cannot occur in individuals, particularly those who are at greater risk. Therefore, monitoring is still important. Evidence suggests that ECT does cause deficits in autobiographical memory. The evidence for schedules of testing to monitor cognitive side-effects is currently limited. We therefore make practical recommendations based on clinical experience.
Despite modern ECT techniques, cognitive side-effects remain an important issue, although their nature and degree remains to be clarified fully. In these circumstances it is useful for clinicians to have guidance regarding what to tell patients and how to monitor these side-effects clinically.
The term ‘mood stabiliser’ is ill-defined and lacks clinical utility. We propose a framework to evaluate medications and effectively communicate their mood stabilising properties – their acute and prophylactic efficacy across the domains of mania and depression. The standardised framework provides a common definition to facilitate research and clinical practice.
Declaration of interest
The Treatment Algorithm Group (TAG) was supported logistically by Servier who provided financial assistance with travel and accommodation for those TAG members travelling interstate or overseas to attend the meeting in Sydney (held on 18 November 2017). None of the committee were paid to participate in this project and Servier have not had any input into the content, format or outputs from this project.
This article presents the results of a program of radiocarbon dating and Bayesian modeling from the precontact Yup'ik site of Nunalleq (GDN-248) in subarctic southwestern Alaska. Nunalleq is deeply stratified, presenting a robust relative chronological framework of well-defined individual house floors abundant in ecofacts suitable for radiocarbon dating. Capitalizing on this potential, we present the results of one of the first applications of Bayesian statistical modeling of radiocarbon data from an archaeological site in the North American Arctic. Using these methods, we demonstrate that it is possible to generate robust, high-resolution chronological models from Arctic archaeology. Radiocarbon dates, procured prior to the program of dating and modeling presented here, suggested an approximately three-century duration of occupation at the site. The results of Bayesian modeling nuance this interpretation. While it is possible that there may have been activity for almost three centuries (beginning in the late fourteenth century), occupation of the dwelling complex, which dominates the site, was more likely to have endured for no more than a century. The results presented here suggest that the occupation of Nunalleq likely encompassed three generations beginning cal AD 1570–1630 before being curtailed by conflict around cal AD 1645–1675.
The long-distance transport of the bluestones from south Wales to Stonehenge is one of the most remarkable achievements of Neolithic societies in north-west Europe. Where precisely these stones were quarried, when they were extracted and how they were transported has long been a subject of speculation, experiment and controversy. The discovery of a megalithic bluestone quarry at Craig Rhos-y-felin in 2011 marked a turning point in this research. Subsequent excavations have provided details of the quarrying process along with direct dating evidence for the extraction of bluestone monoliths at this location, demonstrating both Neolithic and Early Bronze Age activity.
This investigation examined the relationship between teachers’ beliefs and their preferences for classroom interventions for behaviours consistent with attention-deficit/hyperactivity disorder (ADHD). Teacher ratings of intervention acceptability, effectiveness, and rate of change were compared across United States and New Zealand samples. Beliefs examined were personal teaching efficacy, general teaching efficacy, and pupil control ideology (PCI). Samples were compared regarding their preferences for the daily report card, response cost technique, classroom lottery, and medication as classroom strategies for managing ADHD-related behavioural concerns. Data were analysed using general linear modelling techniques, and an interaction was demonstrated between ADHD intervention x PCI x nationality. Differences were observed for ADHD interventions across samples based upon pupil control orientations. Implications for educators and their classroom practices are discussed.
Bentley et al.'s scheme generates distributions characteristic of situations of high and low social influence on decisions and of high and low salience (“transparency”) of rewards. Another element of decisions that may influence the placement of a decision process in their map is the way in which individual decisions interact to determine the payoffs. This commentary discusses the role of Nash equilibria in game theory, focusing especially on coordination and anti-coordination games.
Spinoza ( 1996: 68) famously criticized those who, when writing about human affairs, “treat not of natural things, which follow the common laws of Nature, but of things which are outside Nature”. If a naturalist is someone who endorses this criticism, most Anglo-American philosophers are naturalists. Ethics, however, represents something of an anomaly, for here the dominant tone is, if not supernaturalist, then decidedly non-naturalistic. The selfsame considerations which prompt philosophers to be naturalistic realists in their metaphysics seem to urge anti-realism in ethics. The dominant image has us projecting our values onto a disenchanted landscape.
Most of the key figures in the now familiar story of the renaissance of virtue ethics would consider themselves naturalists, and yet their naturalism is very different from that found in metaphysics, epistemology or the philosophy of mind. Aside from debates about character, there is little serious engagement with empirical science. My aim in this chapter is to evaluate the peculiar form of naturalism that is found in virtue ethics rather than in ethical naturalism more broadly. I will argue that while there are good reasons to distance virtue ethics from scientistic naturalism, we should be wary of “conceptual purism”: the idea that philosophy should have no truck with empirical matters. While such a position does insulate virtue ethics from some fairly devastating criticisms emanating from the biological sciences, it concedes too much to scientistic naturalism in its conception of what an engagement with the sciences must look like.
We present the first radiocarbon dates from previously unrecorded, secondary burials in the Cardamom Mountains, Cambodia. The mortuary ritual incorporates nautical tradeware ceramic jars and log coffins fashioned from locally harvested trees as burial containers, which were set out on exposed rock ledges at 10 sites in the eastern Cardamom Massif. The suite of 28 14C ages from 4 of these sites (Khnorng Sroal, Phnom Pel, Damnak Samdech, and Khnang Tathan) provides the first estimation of the overall time depth of the practice. The most reliable calendar date ranges from the 4 sites reveals a highland burial ritual unrelated to lowland Khmer culture that was practiced from cal AD 1395 to 1650. The time period is concurrent with the 15th century decline of Angkor as the capital of the Khmer kingdom and its demise about AD 1432, and the subsequent shift of power to new Mekong trade ports such as Phnom Penh, Udong, and Lovek. We discuss the Cardamom ritual relative to known funerary rituals of the pre- to post-Angkorian periods, and to similar exposed jar and coffin burial rituals in Mainland and Island Southeast Asia.
The major European powers drafted war plans before 1914 and executed them in August 1914; none brought the expected victory by Christmas. Why? This tightly focused collection of essays by international experts in military history reassesses the war plans of 1914 in a broad diplomatic, military, and political setting for the first time in three decades. The book analyzes the war plans of Austria-Hungary, France, Germany, Great Britain, Italy, and Russia on the basis of the latest research and explores their demise in the opening months of World War I. Collectively and comparatively, these essays place contingency war planning before 1914 in the different contexts and challenges each state faced as well as into a broad European paradigm. This is the first such undertaking since Paul Kennedy's groundbreaking War Plans of the Great Powers (1979), and the end result is breathtaking in both scope and depth of analysis.
Wars are curious, puzzling, problematic events. Sensible people everywhere know that wars can be extremely costly in lives, property, and money. And they know that their outcomes are uncertain. Yet they still happen. Few other human activities have stimulated as much thought as the simple question: Why do wars happen? More often than not, the concern is with specific wars such as World War I, once called the Great War. The basic question: what happened in August 1914? Or, more precisely, why did the leaders of Europe's major powers choose war?
A formal answer to that question, something discussed in a previous work, The Origins of World War I, is that in each case a small coterie, the nation's leaders, made the decisions that took the nation to war. Those leadership groups assessed current situations, defined the threats, considered alternatives, and chose war as their most appropriate option, either initiating action or responding to another nation's initiative. In each case, moving a step beyond that formal statement, the participants had specific strategic agendas. Austria-Hungary's leaders were seeking to prevent dissolution of the empire, a threat they sensed as stemming from Serbia's initiatives. Germany's leaders saw the threat of a two-front war with France and Russia arming and becoming ever more dangerous. For Germany's leaders the events of July and August 1914 provided a twofold opportunity, to protect their most valued ally, Austria-Hungary, and to remove the threat posed by the entente powers.