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The 11th revision to the WHO International Classification of Diseases (ICD-11) identified complex post-traumatic stress disorder (CPTSD) as a new condition. There is a pressing need to identify effective CPTSD interventions.
We conducted a systematic review and meta-analysis of randomised controlled trials (RCTs) of psychological interventions for post-traumatic stress disorder (PTSD), where participants were likely to have clinically significant baseline levels of one or more CPTSD symptom clusters (affect dysregulation, negative self-concept and/or disturbed relationships). We searched MEDLINE, PsycINFO, EMBASE and PILOTS databases (January 2018), and examined study and outcome quality.
Fifty-one RCTs met inclusion criteria. Cognitive behavioural therapy (CBT), exposure alone (EA) and eye movement desensitisation and reprocessing (EMDR) were superior to usual care for PTSD symptoms, with effects ranging from g = −0.90 (CBT; k = 27, 95% CI −1.11 to −0.68; moderate quality) to g = −1.26 (EMDR; k = 4, 95% CI −2.01 to −0.51; low quality). CBT and EA each had moderate–large or large effects on negative self-concept, but only one trial of EMDR provided useable data. CBT, EA and EMDR each had moderate or moderate–large effects on disturbed relationships. Few RCTs reported affect dysregulation data. The benefits of all interventions were smaller when compared with non-specific interventions (e.g. befriending). Multivariate meta-regression suggested childhood-onset trauma was associated with a poorer outcome.
The development of effective interventions for CPTSD can build upon the success of PTSD interventions. Further research should assess the benefits of flexibility in intervention selection, sequencing and delivery, based on clinical need and patient preferences.
The Great Shearers’ Strike of 1891 transformed Australian politics and created the context for the election of the first ‘labourist’ government in the world. This nationally significant history is reflected in Barcaldine’s central heritage precinct, with a large monument to the Tree of Knowledge and spacious Australian Workers Heritage Centre. The Centre was established as the ‘National Monument’ to working men and women when it was opened by Prime Minister Bob Hawke in 1991. The Centre is one of a number of industrial museums in the Central West, and exists alongside the Stockman’s Hall of Fame in nearby Longreach. The recent increase in tourism by Grey Nomads has resulted in a more concerted effort to formulate a clear heritage discourse in Barcaldine, one that draws on the town’s labour heritage. This increased emphasis on the heritage of the Great Shearers’ Strike has further politicised an already fraught heritage, and distanced the community from its local heritage spaces and stories. This article reflects on long-standing narratives relating to the local environment as a means to articulate contested heritage discourses, situate the significant labour history and reinforce the local community’s engagement in its heritage.
Benzobicyclon will be the first 4-hydroxyphenylpyruvate dioxygenase (HPPD)–inhibiting herbicide available in US rice production pending registration completion. An observation of benzobicyclon controlling weedy rice in two field trials prompted a greenhouse and field evaluation to determine if benzobicyclon would control weedy rice accessions from Arkansas, Mississippi, and southeastern Missouri. A total of 100 accessions were screened in the greenhouse and field. Percentage mortality was determined in the greenhouse, and percentage control was recorded in the field. Benzobicyclon at 371 g ai ha–1 caused at least 80% mortality of 22 accessions in the greenhouse and at least 80% control of 30 accessions in the field. For most accessions, individual plants within the accession varied in response to benzobicyclon. Based on these results, the sensitivity of weedy rice to benzobicyclon varies across accessions collected in the midsouthern United States, and it may provide an additional control option for weedy rice in some fields.
In September 2016, the annual meeting of the International Union for Quaternary Research’s Loess and Pedostratigraphy Focus Group, traditionally referred to as a LoessFest, met in Eau Claire, Wisconsin, USA. The 2016 LoessFest focused on “thin” loess deposits and loess transportation surfaces. This LoessFest included 75 registered participants from 10 countries. Almost half of the participants were from outside the United States, and 18 of the participants were students. This review is the introduction to the special issue for Quaternary Research that originated from presentations and discussions at the 2016 LoessFest. This introduction highlights current understanding and ongoing work on loess in various regions of the world and provides brief summaries of some of the current approaches/strategies used to study loess deposits.
Increasingly, ambulance services offer alternatives to transfer to the emergency department (ED), when this is better for patients. The introduction of electronic health records (EHR) in ambulance services is encouraged by national policy across the United Kingdom (UK) but roll-out has been variable and complex.
Electronic Records in Ambulances (ERA) is a two-year study which aims to investigate and describe the opportunities and challenges of implementing EHR and associated technology in ambulances to support a safe and effective shift to out of hospital care, including the implications for workforce in terms of training, role and clinical decision-making skills.
Our study includes a scoping review of relevant issues and a baseline assessment of progress in all UK ambulance services in implementing EHR. These will inform four in-depth case studies of services at different stages of implementation, assessing current usage, and examining context.
The scoping review identified themes including: there are many perceived potential benefits of EHR, such as improved safety and remote diagnostics, but as yet little evidence of them; technical challenges to implementation may inhibit uptake and lead to increased workload in the short term; staff implementing EHR may do so selectively or devise workarounds; and EHR may be perceived as a tool of staff surveillance.
Our scoping review identified some complex issues around the implementation of EHR and the relevant challenges, opportunities and workforce implications. These will help to inform our fieldwork and subsequent data analysis in the case study sites, to begin early in 2017. Lessons learned from the experience of implementing EHR so far should inform future development of information technology in ambulance services, and help service providers to understand how best to maximize the opportunities offered by EHR to redesign care.
Benzobicyclon is the first 4-hydroxyphenylpyruvate dioxygenase-inhibiting herbicide pursued for commercial registration in U.S. rice production. A study was conducted in 2015 and 2016 to evaluate the response of eight rice cultivars to post-flood application timings of benzobicyclon at 494 g ai ha-1 (proposed 2X rate). ‘Caffey’, ‘CL151’, ‘CLXL745’, ‘Jupiter’, ‘LaKast’, ‘Mermentau’, ‘Roy J’, and ‘XL753’ were evaluated in response to applications of benzobicyclon. The highest level of visible injury was observed in LaKast at 7% in 2015. No visible injury was detected among other cultivars either year at 2 weeks after treatment. In 2015 and 2016, no more than a four-day delay to reach 50% heading occurred across all cultivars. Rough rice yield was not affected by any of the post-flood application timings of benzobicyclon. A second study was conducted in 2016 at three locations throughout Arkansas to investigate the tolerance of 19 tropical japonica (inbred and hybrid) and two indica inbred cultivars to a premix containing benzobicyclon at 494 g ai ha-1 and halosulfuron at 72 g ai ha-1 applied 1 week after flooding. The tropical japonica cultivars have excellent crop safety to benzobicyclon while application to the indica cultivars, Rondo and Purple Marker, expressed severe phytotoxicity. Benzobicyclon caused less than a 2 d delay in heading to the japonica cultivars. Rough rice yield of the tropical japonica cultivars was not affected by benzobicyclon while yields of both indica cultivars were negatively affected. Benzobicyclon can safely be applied to drill-seeded tropical japonica inbred and hybrid cultivars in a post-flood application without concerns for crop injury. Benzobicyclon should not be used on indica cultivars as it will cause severe injury, delayed heading, and yield loss.
The ‘future’ orientation of the out-of-home care research literature which has focused on outcomes of care has risked ignoring children's experiences of care in their ‘present(s)’. In this paper we describe a project, the design of which reflects an alternative to the traditional way of looking at childhood, of which this ‘future’ (adult constructed) orientation is part. We discuss the use of qualitative research methods to identify children's needs in care. The project has attempted to involve children as co-constructors of knowledge around their needs through participatory research methods. These methods have required us to recognise that children and their needs exist within a context of relational structures; to address the power imbalances between adult researchers and child participants; and to be flexible in responding to the consequences of a participative process. Challenges which have surfaced in the implementation of this research and our responses to them are described.
This paper outlines a three-year collaborative research project which aims to involve children and young people, as well as other stakeholders, in exploring strategies to meet the needs of children in care. In this paper we identify some research findings which indicate the importance of children participating in the defining of their needs in care, if these needs are to be responded to more effectively than has been the case in the past. We describe the aims of our three-year project and identify some of the methodological issues of implementing stage one of the project in terms of children’s participation. A conceptual framework is developed to clarify issues related to children’s participation in research and decision making and as a basis for deciding on appropriate research methods to employ in the first stage. Rather than merely outlining the work we have so far undertaken, we have insteadfocussed on reflecting on and analysing the theoretical and methodological challenges to researchers in implementing collaborative and participatory research in decision making with children.
Nanoparticles have applications in a diverse range of products including medications, detergents, cosmetics, paint, sunscreen and electronics, with an economic worth projected to reach $2.5 trillion dollars in 2015. Research into the effects of manufactured nanomaterials on the environment, however, has failed to keep pace with the high volume of commercial production. Whereas a number of studies have examined the effects of nanoparticles on aquatic species, little work has focused on the way in which benthic marine species encounter, ingest and depurate these materials. The purpose of this study was to examine the ingestion and depuration of titania nanoparticles (anatase) by the blue mussel (Mytilus edulis) and the eastern oyster (Crassostrea virginica) during a spill scenario (an acute exposure to elevated concentrations). Bivalves were exposed to nanoparticles either incorporated into marine snow, an environmentally relevant medium for pollutants, or added directly to seawater at a concentration of 4.5 mg L−1 for 2 h. After feeding, the animals were transferred to filtered seawater and allowed to depurate. Faeces and tissues were collected at 0, 6, 24, 72 and 120 h, post-exposure, and analysed for concentrations of titanium by inductively coupled plasma-mass spectrometry. Results indicated that the capture and ingestion of titania nanoparticles by both species was not dependent on the method of delivery (incorporated into marine snow or freely suspended). Additionally, greater than 90% of the titania nanoparticles, on average, were eliminated from the tissues after 6 h, and only trace amounts remained after 72 h. These data demonstrate that mussels and oysters readily ingest titania nanoparticles, but rapidly depurate the material within hours of an acute exposure suggesting that little would be transferred to secondary consumers including humans. Further research is required to determine if other species of suspension-feeders handle titania nanoparticles in a manner similar to bivalves.
Materiality and the material are important in medieval romance. The essays here focus both on the physical forms of romance texts (manuscripts, verse form, illustrations and visual portryals), and on how romances themselves inhabit and reflect on the material culture of the Middle Ages. Specific themes discussed include social, historical, and physical space; bodies and gender politics; and romance illustrations in manuscripts, and in other media. Nicholas Perkins is University Lecturer and Tutor in medieval English, University of Oxford. Contributors: Siobhain Bly Calkin, Nancy Mason Bradbury, Aisling Byrne, Anna Caughey, Neil Cartlidge, Mark Cruse, Morgan Dickson, Rosalind Field, Elliott Kendall, Megan Leitch, Henrike Manuwald, Ad Putter, Raluca Radulescu, Robert Rouse,