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.
Having faced multiple traumatic events and severe losses linked to situations of organized violence in their home countries, refugees might experience a loss of connection due to the destruction of important social bonds and a fragmentation of cultural structures. Studies provide growing evidence that cultural belonging and political mobilization may play an important role in reconstructing meaning and connection in the wake of collective violence, loss, and exile. In this chapter, we explore the role of these collective identifications in post-trauma reconstruction through the case of Kurdish refugee families. Thematic analysis of family and parent interviews indicates how the intra-familial transmission of collective identifications may operate as a source of dealing with cultural bereavement and loss, commemorating trauma, and reversing versus reiterating trauma. The findings support an explorative understanding of collective identifications as meaningful resources in refugee families’ post-trauma reconstruction. Our analysis also identifies a paradox between reparative and potentially perilous aspects of collective identifications.
Less is known about the relationship between conduct disorder (CD), callous–unemotional (CU) traits, and positive and negative parenting in youth compared to early childhood. We combined traditional univariate analyses with a novel machine learning classifier (Angle-based Generalized Matrix Learning Vector Quantization) to classify youth (N = 756; 9–18 years) into typically developing (TD) or CD groups with or without elevated CU traits (CD/HCU, CD/LCU, respectively) using youth- and parent-reports of parenting behavior. At the group level, both CD/HCU and CD/LCU were associated with high negative and low positive parenting relative to TD. However, only positive parenting differed between the CD/HCU and CD/LCU groups. In classification analyses, performance was best when distinguishing CD/HCU from TD groups and poorest when distinguishing CD/HCU from CD/LCU groups. Positive and negative parenting were both relevant when distinguishing CD/HCU from TD, negative parenting was most relevant when distinguishing between CD/LCU and TD, and positive parenting was most relevant when distinguishing CD/HCU from CD/LCU groups. These findings suggest that while positive parenting distinguishes between CD/HCU and CD/LCU, negative parenting is associated with both CD subtypes. These results highlight the importance of considering multiple parenting behaviors in CD with varying levels of CU traits in late childhood/adolescence.
This paper sets out the socio-spatial practices of PS2 and Street Society in territorialised, post conflict Northern Ireland – whose work combines pedagogical and improvisation theory to prototype distinctive social models. These practices were formed by a continual process of practical involvement and reflection (through writing) and evaluation (funding permitting), alongside the author-practitioners' search for theoretical concepts that would bring clarity and an alternative perspective to the processes and outcomes. Concepts and approaches taken from pedagogical theory and, uniquely in the case of architecture, improvisational theory, will be used to explore critical aspects of the specific practices, and more generally assert that such socio-spatial ‘street pedagogy’ offers a space of rehearsal and ultimately, a site for the development of socially-just aesthetics. The paper thus proposes a theoretical scaffolding for practices which increase diversity and diminish resource consumption in the contexts of climate emergency and a politics of precarity.
The COVID-19 pandemic requires an effort to coordinate the actions of government and society in a way unmatched in recent history. Individual citizens need to voluntarily sacrifice economic and social activity for an indefinite period of time to protect others. At the same time, we know that public opinion tends to become polarized on highly salient issues, except when political elites are in consensus (Berinsky, 2009; Zaller, 1992). Avoiding elite and public polarization is thus essential for an effective societal response to the pandemic. In the United States, there appears to be elite and public polarization on the severity of the pandemic (Gadarian et al., 2020). Other evidence suggests that polarization is undermining compliance with social distancing (Cornelson and Miloucheva, 2020). Using a multimethod approach, we show that Canadian political elites and the public are in a unique period of cross-partisan consensus on important questions related to the COVID-19 pandemic, such as its seriousness and the necessity of social distancing.
Optimal stroke care requires access to resources such as neuroimaging, acute revascularization, rehabilitation, and stroke prevention services, which may not be available in rural areas. We aimed to determine geographic access to stroke care for residents of rural communities in the province of Ontario, Canada.
We used the Ontario Road Network File database linked with the 2016 Ontario Acute Stroke Care Resource Inventory to estimate the proportion of people in rural communities, defined as those with a population size <10,000, who were within 30, 60, and 240 minutes of travel time by car from stroke care services, including brain imaging, thrombolysis treatment centers, stroke units, stroke prevention clinics, inpatient rehabilitation facilities, and endovascular treatment centers.
Of the 1,496,262 people residing in rural communities, the majority resided within 60 minutes of driving time to a center with computed tomography (85%), thrombolysis (81%), a stroke unit (68%), a stroke prevention clinic (74%), or inpatient rehabilitation (77.0%), but a much lower proportion (32%) were within 60 minutes of driving time to a center capable of providing endovascular thrombectomy (EVT).
Most rural Ontario residents have appropriate geographic access to stroke services, with the exception of EVT. This information may be useful for jurisdictions seeking to optimize the regional organization of stroke care services.
Metabolic syndrome (MetS) is associated with reduced life expectancy in patients with affective disorders, however, whether MetS also plays a role before the onset of affective disorder is unknown. We aimed to investigate whether MetS, inflammatory markers or oxidative stress act as risk factors for affective disorders, and whether MetS is associated with increased inflammation and oxidative stress.
We conducted a high-risk study including 204 monozygotic (MZ) twins with unipolar or bipolar disorder in remission or partial remission (affected), their unaffected co-twins (high-risk) and twins with no personal or family history of affective disorder (low-risk). Metabolic Syndrome was ascertained according to the International Diabetes Federation (IDF) criteria. Inflammatory markers and markers of oxidative stress were analyzed from fasting blood and urine samples, respectively.
The affected and the high-risk group had a significantly higher prevalence of MetS compared to the low-risk group (20% v. 15% v. 2.5%, p = 0.0006), even after adjusting for sex, age, smoking and alcohol consumption. No differences in inflammatory and oxidative markers were seen between the three groups. Further, MetS was associated with alterations in inflammatory markers, and oxidative stress was modestly correlated with inflammation.
Metabolic syndrome is associated with low-grade inflammation and may act as a risk factor and a trait marker for affective disorders. If confirmed in longitudinal studies, this suggests the importance of early intervention and preventive approaches targeted towards unhealthy lifestyle factors that may contribute to later psychopathology.
The global ageing population and the long prodromal period for the development of cognitive decline and dementia brings a need to understand the antecedents of both successful and impaired cognitive ageing. It is increasingly apparent that the trajectory of risk-factor change, as well as the level of the risk factor, may be associated with an increased or decreased risk of cognitive decline or dementia.
Our aim was to summarise the published evidence and to generate hypotheses related to risk-factor trajectories and risk of incident cognitive decline or dementia.
We collated data from longitudinal observational studies relating to trajectory of blood pressure, obesity and cholesterol and later cognitive decline or dementia using standard systematic review methodology. The databases MEDLINE, Embase and PsycINFO were searched from inception to 26 April 2018.
Thirteen articles were retained for inclusion. Analytical methods varied. Our summary of the current evidence base suggests that first body mass index and then blood pressure rises and then falls more steeply in those who go on to develop dementia. The evidence for cholesterol was less consistent.
Based on our review we present the hypothesis that weight falls around 10 years and blood pressure around 5 years before diagnosis. Confirmatory work is required. However, characterisation of risk according to combinations and patterns of risk factors may ultimately be integrated into the assessments used to identify those at risk of receiving a diagnosis of cognitive decline or dementia in late life.
In late summer, sometime between cal a.d. 340–405, a hoard of tightly packed, stacked copper-alloy vessels was deposited in the Vale of Pewsey, Wiltshire. The corrosion of the vessels allowed for the preservation of delicate plant macrofossils and pollen. Analysis of this material has provided insights into the date, season and context of this act of structured deposition. A second hoard of similar vessels was deposited in the fourth or fifth century only a few miles away at Wilcot. The hoards and their deposition relate to Romano-British lifeways, at a time when the region was on the cusp of a dramatic period of change. The distribution of late Roman coins and belt fittings offers further insights into the social and economic character of Wiltshire at their times of deposition.
This study explored the concept of ‘giving up’ from the perspective of care staff working in care homes, and their everyday communication and hidden knowledge concerning what they think about this taboo topic and the context it reflects. Moving to a care home is a major transition where cumulative losses can pose risks to mental health in later life. If not recognised, this vulnerability can lead to depression which extends to suicide ideation and behaviours in the form of self-harm and self-neglect. Care homes are a significant place of care until death, yet a discourse of silence means that self-harm and suicide is under-reported or not attended to with specialist expertise. The layperson's concept of an older person ‘giving up’ on life is hardly discussed in the literature. This co-produced qualitative study used an inductive approach to explore this phenomenon through focus groups with 33 care staff across four care homes in South-East England. Findings paint a complex picture, highlighting tensions in providing the right support and creating spaces to respond to such challenging situations. ‘Giving up’ requires skilled detailed assessment to respond to risks alongside improved training and support for paid carers, to achieve a more holistic strategy which capitalises on significant relationships within a wider context.
Despite the fact that urbanisation, population ageing and international migration constitute major societal developments of our time, little attention has been paid to studying them together in a comprehensive manner. In this paper, we argue that, when treating age and ethnicity as practical processes for addressing and identifying with social groups, it is necessary to do so from a ‘doing’ perspective. The question we ask focuses on which social memberships are made relevant or irrelevant in residential environments and how that relevance or irrelevance is established. Drawing upon a quantitative study among individuals of Turkish migrant origin living in Vienna, Austria, we find that it is rather common for the respondents to have been assigned to multiple intersecting social groups and that they were treated unfairly in their own neighbourhoods. However, such ascriptions do not necessarily correspond to objective categorisations of research or subjective identifications. Hence, the discrimination that is present in a neighbourhood does not necessarily lead to decreased place attachment or a diminishing sense of home. In fact, we find that the ‘satisfaction paradox’ is quite common in environmental gerontology and that it may actually intersect with the ‘immigration paradox’. Applying processual intersectionality is not only fruitful for research, it can also improve the conceptualisation of age-friendly cities.
Emerging genetic, ex-vivo, and clinical trial evidence indicates that calcium channel blockers (CCB) can improve mood and cognitive function. The objective of this study was to examine the effect of selective serotonin reuptake inhibitor (SSRI) therapy augmented with CCB on depression and cognitive decline in an elderly population with hypertension.
Prospective study of 296 persons treated with SSRI and antihypertensive drugs. Baseline and two year clinic assessments were used to categorize participants as users of SSRI + CCB (n = 53) or users of SSRI + other antihypertensives (n = 243). Clinic visits were performed up to four times in a ten-year period to assess depression and cognitive function.
The sample mean age was 75.2 ± 5.47 years and 78% of participants were female. At two year follow-up there was a significant group by time interaction showing lower Center for Epidemiological Studies-Depression (CESD) scores in the SSRI + CCB group, F(1,291) = 4.13, p = 0.043, η2p = 0.014. Over ten-years follow-up, SSRI + CCB use was associated with improved general cognitive function (Mini-Mental State Examination: β = 0.97; 95% CI 0.14 to 1.81, p = 0.023) and immediate visual memory (Boston Visual Retention Test: β = 0.69; 95% CI 0.06 to 1.32, p = 0.033).
The findings provide general population evidence that SSRI augmentation with CCB may improve depression and cognitive function.
Urban slums provide suitable conditions for infestation by rats, which harbour and shed a wide diversity of zoonotic pathogens including helminths. We aimed to identify risk factors associated with the probability and intensity of infection of helminths of the digestive tract in an urban slum population of Rattus norvegicus. Among 299 rats, eleven species/groups of helminths were identified, of which Strongyloides sp., Nippostrongylus brasiliensis and, the human pathogen, Angiostrongylus cantonensis were the most frequent (97, 41 and 39%, respectively). Sex interactions highlighted behavioural differences between males and females, as eg males were more likely to be infected with N. brasiliensis where rat signs were present, and males presented more intense infections of Strongyloides sp. Moreover, rats in poor body condition had higher intensities of N. brasiliensis. We describe a high global richness of parasites in R. norvegicus, including five species known to cause disease in humans. Among these, A. cantonensis was found in high prevalence and it was ubiquitous in the study area – knowledge which is of public health importance. A variety of environmental, demographic and body condition variables were associated with helminth species infection of rats, suggesting a comparable variety of risk factors for humans.
Dementia is a neurodegenerative disorder with global impact, with the largest proportion of cases occurring in low- and middle-income countries. It is estimated that there are 46.8 million cases globally with approximately 10 million new cases each year or a new case occurring every 3 sec (Prince et al., 2015). For comparison there are 36.7 million HIV cases with an estimated 2 million new cases each year (WHO, 2017). The rise in dementia prevalence is largely due to population ageing, with the oldest being at highest risk. To date there are no diseases modifying medications for Alzheimer's disease or the other causes of dementia. Academics and research groups are increasingly focused on prevention or delay of dementia (Brayne and Miller, 2017) and a number of organizations now prioritize dementia, indicating a strong and coherent international effort to address this problem. Examples include the World Health Organisation (WHO), which has established a Global Dementia Observatory; the World Dementia Council; the Organisation for Economic Co-operation and Development (OECD); the U.S. National Alzheimer's Project Act (NAPA); and the Global Council on Brain Health.
Understanding the drivers of recent change at Greenlandic tidewater glaciers is of great importance if we are to predict how these glaciers will respond to climatic warming. A poorly constrained component of tidewater glacier processes is the near-terminus subglacial hydrology. Here we present a novel method for constraining near-terminus subglacial hydrology with application to marine-terminating Kangiata Nunata Sermia in South-west Greenland. By simulating proglacial plume dynamics using buoyant plume theory and a general circulation model, we assess the critical subglacial discharge, if delivered through a single compact channel, required to generate a plume that reaches the fjord surface. We then compare catchment runoff to a time series of plume visibility acquired from a time-lapse camera. We identify extended periods throughout the 2009 melt season where catchment runoff significantly exceeds the discharge required for a plume to reach the fjord surface, yet we observe no plume. We attribute these observations to spatial spreading of runoff across the grounding line. Persistent distributed drainage near the terminus would lead to more spatially homogeneous submarine melting and may promote more rapid basal sliding during warmer summers, potentially providing a mechanism independent of ocean forcing for increases in atmospheric temperature to drive tidewater glacier acceleration.
Use of artificial light resulted in relative independence from the natural light–dark (LD) cycle, allowing human subjects to shift the timing of food intake and work to convenient times. However, the increase in artificial light exposure parallels the increase in obesity prevalence. Light is the dominant Zeitgeber for the central circadian clock, which resides within the hypothalamic suprachiasmatic nucleus, and coordinates daily rhythm in feeding behaviour and metabolism. Eating during inappropriate light conditions may result in metabolic disease via changes in the biological clock. In this review, we describe the physiological role of light in the circadian timing system and explore the interaction between the circadian timing system and metabolism. Furthermore, we discuss the acute and chronic effects of artificial light exposure on food intake and energy metabolism in animals and human subjects. We propose that living in synchrony with the natural daily LD cycle promotes metabolic health and increased exposure to artificial light at inappropriate times of day has adverse effects on metabolism, feeding behaviour and body weight regulation. Reducing the negative side effects of the extensive use of artificial light in human subjects might be useful in the prevention of metabolic disease.
This issue of Byzantine and Modern Greek Studies is special for two reasons: it celebrates forty years of our journal's publication, and it is the first issue to be produced by our new publisher, Cambridge University Press. The issue is dedicated to Anthony Bryer, who was appointed to teach Byzantine History at Birmingham in 1964. Bryer was one of the leading figures in the creation of the journal and has been a member of the editorial board ever since the first issue appeared in 1975; he also served as the Business Editor from 1984 to 1994.
Background: Transient ischemic attack (TIA) and minor stroke are associated with
a substantial risk of subsequent stroke; however, there is uncertainty about
whether such patients require admission to hospital for their initial
management. We used data from a clinical stroke registry to determine the
frequency and predictors of hospitalization for TIA or minor stroke across
the province of Ontario, Canada. Methods: The Ontario Stroke Registry collects information on a
population-based sample of all patients seen in the emergency department
with acute stroke or TIA in Ontario. We identified patients with minor
ischemic stroke or TIA included in the registry between April 1, 2008, and
March 31, 2011, and used multivariable analyses to evaluate predictors of
hospitalization. Results: Our study sample included 8540 patients with minor ischemic stroke
or TIA, 47.2% of whom were admitted to hospital, with a range of 37.6% to
70.3% across Ontario’s 14 local health integration network regions. Key
predictors of admission were preadmission disability, vascular risk factors,
presentation with weakness, speech disturbance or prolonged/persistent
symptoms, arrival by ambulance, and presentation on a weekend or during
periods of emergency department overcrowding. Conclusions: More than one-half of patients with minor stroke or TIA were not
admitted to the hospital, and there were wide regional variations in
admission patterns. Additional work is needed to provide guidance to health
care workers around when to admit such patients and to determine whether
discharged patients are receiving appropriate follow-up care.
Psychological interventions may be beneficial in bipolar disorder.
To evaluate the efficacy of psychological interventions for adults with
A systematic review of randomised controlled trials was conducted.
Outcomes were meta-analysed using RevMan and confidence assessed using
the GRADE method.
We included 55 trials with 6010 participants. Moderate-quality evidence
associated individual psychological interventions with reduced relapses
at post-treatment (risk ratio (RR) = 0.66, 95% CI 0.48–0.92) and
follow-up (RR = 0.74, 95% CI 0.63–0.87), and collaborative care with a
reduction in hospital admissions (RR =0.68, 95% CI 0.49–0.94).
Low-quality evidence associated group interventions with fewer depression
relapses at post-treatment and follow-up, and family psychoeducation with
reduced symptoms of depression and mania.
There is evidence that psychological interventions are effective for
people with bipolar disorder. Much of the evidence was of low or very low
quality thereby limiting our conclusions. Further research should
identify the most effective (and cost-effective) interventions for each
phase of this disorder.