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In this essay, I distinguish two dimensions of responsibility: (i) responsibility for expressing the will (character, motives, and purposes) one has in action (voluntarily and without constraint) and (ii) responsibility for having the will one expresses in action. I argue that taking both of these dimensions into account is necessary to do full justice to our understanding of moral responsibility and our ordinary practices of holding persons responsible in moral and legal contexts. I further argue that the distinction between these dimensions of responsibility is importantly related to understanding age-old debates about the freedom of the will. For the first dimension of responsibility is historically related to the freedom of action—the power to freely express the will one already has in action. While the second dimension is historically related to the freedom of the will—the power to freely form or shape that will one may later express in action. And I argue that while the freedom of action so defined may be compatible with determinism, the freedom of will, and the deeper responsibility associated with it for forming one’s own will, which I call “ultimate responsibility,” are not compatible with a thoroughgoing determinism. In arguing throughout the essay for these claims and for the need to take into account both of these dimensions to do full justice to our understanding of moral responsibility, I consider ordinary practices of holding persons responsible in a variety of moral and legal contexts, discussing in the process H. L. A. Hart’s “fair opportunity to avoid wrongdoing” criterion for assessing responsibility and blame in legal and criminal contexts, the relevance of recent experimental studies about folk intuitions concerning assessments of responsibility and blame, Harry Frankfurt’s critique of the “principle of alternative possibilities,” the distinction between “will-settled” and “will-setting” actions, and contemporary critiques of the very possibility and intelligibility of an ultimate responsibility for forming one’s own will that would be incompatible with determinism.
Our main result establishes Andrews’ conjecture for the asymptotic of the generating function for the number of integer partitions of
consecutive parts. The methods we develop are applicable in obtaining asymptotics for stochastic processes that avoid patterns; as a result they yield asymptotics for the number of partitions that avoid patterns.
Holroyd, Liggett, and Romik, in connection with certain bootstrap percolation models, introduced the study of partitions without
consecutive parts. Andrews showed that when
, the generating function for these partitions is a mixed-mock modular form and, thus, has modularity properties which can be utilized in the study of this generating function. For
, the asymptotic properties of the generating functions have proved more difficult to obtain. Using
-series identities and the
case as evidence, Andrews stated a conjecture for the asymptotic behavior. Extensive computational evidence for the conjecture in the case
was given by Zagier.
This paper improved upon early approaches to this problem by identifying and overcoming two sources of error. Since the writing of this paper, a more precise asymptotic result was established by Bringmann, Kane, Parry, and Rhoades. That approach uses very different methods.
Background: Mindfulness-based cognitive therapy (MBCT) has evidence of efficacy in a range of populations, but few studies to date have reported on MBCT for treatment of anxious and depressive symptoms in Parkinson's disease (PD). Aims: The aim of this study was to examine the efficacy of modified MBCT in reducing symptoms of anxiety and depression and improving quality of life in PD. Method: Thirty-six individuals with PD were randomly assigned to either modified MBCT or a waitlist control. Changes in symptoms of anxiety, depression and quality of life were compared at group level using generalized linear mixed models and at individual level using reliable change analysis. Results: At post-treatment, there was a significant reduction in depressive symptoms for people undertaking modified MBCT at both group and individual levels compared with controls. There was no significant effect on anxiety or quality of life at the group level, although significantly more people had reliable improvement in anxiety after modified MBCT than after waitlist. Significantly more waitlist participants had reliable deterioration in symptoms of anxiety and depression than those completing modified MBCT. Most participants stayed engaged in modified MBCT, with only three drop-outs. Discussion: This proof-of-concept study demonstrates the potential efficacy of modified MBCT as a treatment for depressive symptoms in Parkinson's disease and suggests further research is warranted.
What constitutes a ‘good place to grow old’? This study aimed to characterise salient features of built and social environments that are essential to support low-income ageing residents. Seated and mobile interviews were conducted with community-dwelling older participants (aged 55–92, mean = 71 years) in three distinct socio-economic and geographic samples of the Minneapolis (Minnesota, United States of America) metropolitan area. The interviews prompted participants to evaluate their homes and neighbourhoods, and probed for particular socio-spatial characteristics that impact residential wellbeing. Qualitative thematic analyses focused on 38 individuals living in subsidised housing and homeless shelters. Four interrelated themes encompassed essential residential qualities: (a) safety and comfort, (b) service access, (c) social connection, and (d) stimulation. These broad ideals, when achieved, enabled participants to cultivate residential wellbeing and fulfilling place attachment. Analyses of the empirical data complicate theoretical assumptions by recognising unequal access to, irregular opportunities for and potential dangers of place attachment. Rich descriptions of participant homelessness, health hazards, crime, lack of supportive infrastructure and social isolation illustrate how place attachment is not inherently positive or necessarily attainable; rather, it is problematic and can involve risk. This article extends geographical gerontology's address of socio-spatial inequalities by focusing on disadvantaged ageing individuals.
This paper extends the existing theories of directed technical change by allowing the factors of production, skilled, and unskilled workers, to be employed in both the skill-intensive and unskilled-intensive sectors. Consequently, the direction of technical progress and the sectoral allocation of factors are jointly determined. The feedback between technical progress and the allocation of factors leads to new results concerning structural change and directed technical change. An increase in the endowment of a factor leads to a dynamic reallocation of factors toward the sector that uses the factor intensively. The reallocation of factors also affects the stability properties of directed technical change. When the parameter conditions necessary for strong bias are satisfied, the interior regime (nonspecialization) is at most locally stable. More importantly, if the relative endowment of skilled labor becomes too high (low), the economy necessarily specializes in the production of skilled (unskilled)-labor-intensive goods. Last, the relationship between the relative endowment of skilled labor and the steady-state relative wage rate is not necessarily monotonic.
Background: The evidence regarding whether co-morbid obsessive compulsive personality disorder (OCPD) is associated with treatment outcomes in obsessive compulsive disorder (OCD) is mixed, with some research indicating that OCPD is associated with poorer response, and some showing that it is associated with improved response. Aims: We sought to explore the role of OCPD diagnosis and the personality domain of conscientiousness on treatment outcomes for exposure and response prevention for OCD. Method: The impact of co-morbid OCPD and conscientiousness on treatment outcomes was examined in a clinical sample of 46 participants with OCD. Results: OCPD diagnosis and scores on conscientiousness were not associated with poorer post-treatment OCD severity, as indexed by Yale-Brown Obsessive Compulsive Scale (YBOCS) scores, although the relative sample size of OCPD was small and thus generalizability is limited. Conclusion: This study found no evidence that OCPD or conscientiousness were associated with treatment outcomes for OCD. Further research with larger clinical samples is required.
Background: Perfectionism is strongly associated with obsessive compulsive disorder (OCD). Cognitive behavioural therapy for perfectionism (CBT-P) has been found to result in reductions in a range of symptoms in individuals with anxiety disorders, depression and eating disorders. Aim: To pilot-test the efficacy of group CBT for perfectionism in participants with OCD and elevated perfectionism. Method: Participants were randomized to receive immediate 8-week group CBT-P (n = 4) or an 8-week waitlist followed by CBT-P (n = 7). Results: Reliable reductions and a large effect size indicated that CBT-P was associated with improvements in perfectionism and OCD severity at post-test. However, these changes were not clinically significant and drop-out was high, resulting in a small final sample. Conclusions: CBT-P may be effective in reducing perfectionism and disorder-specific OCD symptoms. However, the high drop-out rate and lack of clinically significant findings suggest that further research needs to be conducted to determine the efficacy of CBT for perfectionism in OCD.
Perfectionism is a risk and maintaining factor across psychopathology and has been proposed to be a transdiagnostic process. The aim of this study was to examine the reliability and validity of the Clinical Perfectionism Questionnaire (CPQ) in 32 adults (75% female, M age = 35.54 years, SD = 9.71) with a range of psychological disorders, presenting for treatment of clinical perfectionism. There was evidence that the CPQ was correlated with established measures of perfectionism and theoretically related constructs including self-criticism and dichotomous thinking. The CPQ was also able to predict treatment outcome. The internal consistency was not adequate in the current study; however, the sample size was small. Future studies should examine the psychometric properties of the CPQ in a larger sample of individuals with a range of psychological disorders.
An integrated experimental – simulation – control theory approach designed to enable adaptive control of microstructural evolution in polycrystalline metals is described. A micro-heater array, containing ten addressable channels, is used to create desired temperature profiles across thin polycrystalline films in situ to a scanning electron microscope (SEM). The goal is that on heating with controlled temperature profiles, the evolution of grain growth within the film can be continuously monitored and compared to Monte Carlo simulations of trajectories towards a desired microstructure. Feed-forward and feedback control strategies are then used to guide the microstructure along the desired trajectory.
Family caregivers of persons with dementia often require support services to help ease the challenges of providing care. Although the efficacy of some dementia caregiver interventions seems apparent, evidence indicating which types of protocols can best meet the diverse needs of individual families is not yet available. Because of this gap, families must often turn to professionals for such guidance, but it remains unknown whether professionals from different disciplines are more inclined to recommend particular types of services than others. This study assessed whether recommendations of supportive interventions to hypothetical dementia family caregivers differed by professional discipline.
In a cross-sectional survey design, a convenience sample of 422 dementia care professionals across the USA viewed up to 24 randomly selected, hypothetical scenarios that systematically varied characteristics of persons with dementia and their caregivers. For each scenario, 7 possible intervention recommendations were rated. A total of 6,890 scenarios were rated and served as the unit of analysis.
General linear models revealed that discipline was often a stronger predictor of how likely professionals were to recommend dementia caregiver interventions than caregiver, care recipient, or other professional characteristics. Psychotherapists tended to recommend psychoeducation more than other professionals, while those in medicine were more likely to recommend training of the person with dementia and psychotherapy.
The heterogeneity in recommendations suggests that the professional source of information influences the types of support families are directed toward. Empirical evidence should inform these professional judgments to better achieve person-centered care for families.
A Movement Disorder Society (MDS) taskforce recently proposed diagnostic criteria for Parkinson’s disease with features of mild cognitive impairment (PD-MCI). This study first examined the prevalence and nature of PD-MCI in a non-demented cohort using the MDS criteria. Using the generic Monte Carlo simulation method developed by Crawford and colleagues (2007), this study then estimated the base rate of the representative population who would demonstrate PD-MCI due to chance alone. A total of 104 participants with idiopathic PD underwent extensive motor and neuropsychological testing at baseline and 2 years later. The Unified Parkinson’s Disease Rating Scale (UPDRS) was used to assess motor symptoms of PD and a range of established neuropsychological tests was used to assess PD-MCI in accord with MDS criteria. In accord with MDS criteria, 38% of this cohort demonstrated PD-MCI at baseline and 48% at follow-up. Of the 36 participants in the multiple-domain PD-MCI subtype at time-1, 9 (25%) demonstrated no PD-MCI at follow up. Analysis revealed that approximately 13% of the representative population would demonstrate abnormally low scores for 2 of the 9 tests used, thereby meeting MDS criteria for PD-MCI. Clinicians and researchers need to approach a single diagnosis (i.e., based on one assessment) of PD-MCI with considerable caution. (JINS, 2015, 21, 137–145)
Long-acting injectable formulations of antipsychotics are treatment alternatives to oral agents.
To assess the efficacy of aripiprazole once-monthly compared with oral aripiprazole for maintenance treatment of schizophrenia.
A 38-week, double-blind, active-controlled, non-inferiority study; randomisation (2:2:1) to aripiprazole once-monthly 400 mg, oral aripiprazole (10–30 mg/day) or aripiprazole once-monthly 50mg (a dose below the therapeutic threshold for assay sensitivity). (Trial registration: clinicaltrials.gov, NCT00706654.)
A total of 1118 patients were screened, and 662 responders to oral aripiprazole were randomised. Kaplan–Meier estimated impending relapse rates at week 26 were 7.12% for aripiprazole once-monthly 400mg and 7.76% for oral aripiprazole. This difference (−0.64%, 95% CI −5.26 to 3.99) excluded the predefined non-inferiority margin of 11.5%. Treatments were superior to aripiprazole once-monthly 50mg (21.80%, P⩽0.001).
Aripiprazole once-monthly 400mg was non-inferior to oral aripiprazole, and the reduction in Kaplan–Meier estimated impending relapse rate at week 26 was statistically significant v. aripiprazole once-monthly 50 mg.
Prehospital postresuscitation induced hypothermia (IH) has been shown to reduce neurological complications in comatose cardiac-arrest survivors. Retrofitting ambulances to include equipment appropriate to initiate hypothermia, such as refrigeration units for cooled saline, is expensive. The objective of this nonhuman subject research study was to determine if inexpensive, commercially available coolers could, in conjunction with five reusable ice packs, keep two 1 L bags of precooled 0.9% normal saline solution (NSS) at or below 4°C for an average shift of eight to 12 hours in a real-world environment, on board in-service Emergency Medical Service (EMS) units, over varying weather conditions in all seasons.
The coolers were chosen based on availability and affordability from two nationally available brands: The Igloo MaxxCold (Igloo Products Corp., Katy, Texas USA) and Coleman (The Coleman Company, Wichita, Kansas USA). Both are 8.5 liter (nine-quart) coolers that were chosen because they adequately held two 1 L bags of saline solution, along with the reusable ice packs designated in the study design, and were small enough for ease of placement on ambulances. Initial testing of the coolers was conducted in a controlled environment. Thereafter, each EMS unit was responsible to cool the saline to less than 4°C prior to shift. Data were collected by emergency medical technicians, paramedics, and resident physicians working in seven different ambulance squads. Data analysis was performed using repeated measurements recorded over a 12-hour period from 19 individual coolers and were summarized by individual time points using descriptive statistics.
Initial testing determined that the coolers maintained temperatures of 4°C for 12 hours in a controlled environment. On the ambulances, results based on the repeated measurements over time revealed that the saline solution samples as defined in the protocol, remained consistently below 4°C for 12 hours. Utilizing the lower bound of the 2-sided 95% exact binomial confidence intervals, there was less than a five percent chance that saline samples could not be maintained below 4°C for 12 hours, even during the summer months.
Simple, commercially available coolers can maintain two 1 L bags of 0.9% NSS at 4°C for 12 hours in ambulances in varying environmental conditions. This suggests that EMS agencies could inexpensively initiate prehospital IH in appropriate cases.
KaneKE, TomshoRJ, PheasantK, StaufferT, SchoenfeldtB, HamiltonS, KainT, KaneBG. The “ICE” Study: Feasibility of Inexpensive Commercial Coolers on Mobile EMS Units. Prehosp Disaster Med. 2014;29(3):1-8.
Aggressive behaviour in school-aged children presents a significant challenge for society. If not managed, it can result in adverse academic, social, emotional, and behavioural outcomes for the child. In addition, it can create stress for families and become a significant burden for the community as these children reach adolescence and adulthood, and engage in antisocial behaviours. Using a three-step exploratory analytical strategy, this study explored parent and child reports of a diverse range of underlying developmental and clinical variables that have been identified in the literature as predictors of aggressive child behaviour, and which could be addressed within an Australian school or community context. A total of 57 children and their parents were recruited from a referral-based Western Australian child mental health service, and the wider community. A group of 31 clinically aggressive children were identified and compared to a group of 26 non-aggressive children. The aggressive group was reported as having a greater prevalence of internalising symptoms, including anxiety and depression, and their aggressive behaviour was more likely to be of the callous/unemotional type, relative to their non-aggressive counterparts. Significant predictors of belonging to the aggressive group included child social problems, thought problems, attention problems, affective problems, narcissism, symptoms of ADHD and PTS, and low maternal self-esteem. Findings are presented and discussed in the context of established theories. Recommendations for principles of treatment for aggressive children and their families are suggested.
Background: To date no research has investigated the link between Post Traumatic Stress Disorder (PTSD) and perfectionism in a clinical sample. Aims: The aim of the current study was to examine whether there is a relationship between PTSD and perfectionism. This is important to address as many studies have demonstrated a link between other anxiety disorders, eating disorders, depression and perfectionism. The research also aimed to examine whether rumination was a mediator of the relationship between PTSD and perfectionism. Method: The sample consisted of 30 participants who were currently in treatment for PTSD. Results: The results suggest that perfectionism and PTSD symptoms were significantly correlated. In addition, rumination was a significant mediator of the relationship between Concern over Mistakes and PTSD. Conclusions: These findings help increase understanding about the relationships of perfectionism and rumination in PTSD and have implications for the treatment of PTSD.
As graphene technologies progress to commercialization and large-scale manufacturing, issues of material and processing safety will need to be more seriously considered. The single word “graphene” actually represents a family of related materials with large variations in number of layers, surface area, lateral dimensions, stiffness, and surface chemistry. Many of these materials have aerodynamic diameters below 5 μm and can potentially be inhaled into the human lung. Graphene materials show several unique modes of interaction with biological molecules, tissues, and cells. The limited literature suggests that graphene materials can be either benign or harmful and that the biological response varies according to a material’s physicochemical properties and biologically effective dose. The present article reviews the current literature on the graphene–biological interface with an emphasis on the mechanisms and fundamental biological responses relevant to material safety and also to potential biomedical applications
Traumatic brain injury (TBI) is a concern of contemporary military
deployments. Whether milder TBI leads to enduring impairment remains
To determine the influence of deployment TBI, and posttraumatic stress
disorder (PTSD) and depression symptoms on neuropsychological and
A sample of 760 US Army soldiers were assessed pre- and post-deployment.
Outcomes included neuropsychological performances and subjective
In total, 9% of the participants reported (predominantly mild) TBI with
loss of consciousness between pre- and post-deployment. At
post-deployment, 17.6% of individuals with TBI screened positive for PTSD
and 31.3% screened positive for depression. Before and after adjustment
for psychiatric symptoms, TBI was significantly associated only with
functional impairment. Both PTSD and depression symptoms adjusted for TBI
were significantly associated with several neuropsychological performance
deficits and functional impairment.
Milder TBI reported by deployed service members typically has limited
lasting neuropsychological consequences; PTSD and depression are
associated with more enduring cognitive compromise.