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This commentary extends Doris's approach of agency by highlighting the importance of responsibility attributions by observers. We argue that (a) social groups determine which standards are relevant and which actors are responsible, (b) consensus about these attributions may correct individual defeaters, and (c) the attribution of moral responsibility reveals agency of observers and may foster the actors' agency.
Computerised cognitive–behavioural therapy (cCBT) for depression has the potential to be efficient therapy but engagement is poor in primary care trials.
We tested the benefits of adding telephone support to cCBT.
We compared telephone-facilitated cCBT (MoodGYM) (n = 187) to minimally supported cCBT (MoodGYM) (n = 182) in a pragmatic randomised trial (trial registration: ISRCTN55310481). Outcomes were depression severity (Patient Health Questionnaire (PHQ)-9), anxiety (Generalized Anxiety Disorder Questionnaire (GAD)-7) and somatoform complaints (PHQ-15) at 4 and 12 months.
Use of cCBT increased by a factor of between 1.5 and 2 with telephone facilitation. At 4 months PHQ-9 scores were 1.9 points lower (95% CI 0.5–3.3) for telephone-supported cCBT. At 12 months, the results were no longer statistically significant (0.9 PHQ-9 points, 95% CI −0.5 to 2.3). There was improvement in anxiety scores and for somatic complaints.
Telephone facilitation of cCBT improves engagement and expedites depression improvement. The effect was small to moderate and comparable with other low-intensity psychological interventions.
We argue that general social psychological mechanisms (e.g., common group identity) can account for prosocial behavior and cooperative norms without the need for punishing Big Gods. Moreover, prosocial religions often do not prevent conflict within their religious groups. Hence, we doubt whether Big Gods and prosocial religions are more effective than alternative identities in enhancing high-level cooperation.
Instead of enhancing diversity in research groups, we suggest that in order to reduce biases in social psychological research a more basic formulation and systematic testing of theories is required. Following the important but often neglected ecological research approach would lead to systematic variation of stimuli and sometimes representative sampling of stimuli for specific environments.
This volume of the Haskins Society Journal furthers the Society's commitment to historical and interdisciplinary research on the early and central Middle Ages, especially in the Anglo-Saxon, Anglo-Norman, and Angevin worlds but also on the continent. The topics of the essays it contains range from the curious place of Francia in the historiography of medieval Europe to strategies of royal land distribution in tenth-century Anglo-Saxon England to the representation of men and masculinity in the works of Anglo-Norman historians. Essays on the place of polemical literature in Frutolf of Michelsberg's Chronicle, exploration of the relationship between chivalry and crusading in Baudry of Bourgeuil's History, and Cosmas of Prague's manipulation of historical memory in the service of ecclesiastical privilege and priority each extend the volume's engagement with medieval historiography, employing rich continental examples to do so. Investigations of comital personnel in Anjou and Henry II's management of royal forests and his foresters shed new light on the evolving nature of secular governance in the twelfth centuries and challenge and refine important aspects of our view of medieval rule in this period. The volume ends with a wide-ranging reflection on the continuing importance of the art object itself in medieval history and visual studies. Contributors: H.F. Doherty, Kathryn Dutton, Kirsten Fenton, Paul Fouracre, Herbert Kessler, Ryan Lavelle, Thomas J.H. McCarthy, Lisa Wolverton, Simon Yarrow.
Depression is expensive to treat, but providing ineffective treatment is more expensive. Such is the case for many patients who do not respond to antidepressant medication.
To assess the cost-effectiveness of cognitive–behavioural therapy (CBT) plus usual care for primary care patients with treatment-resistant depression compared with usual care alone.
Economic evaluation at 12 months alongside a randomised controlled trial. Cost-effectiveness assessed using a cost-consequences framework comparing cost to the health and social care provider, patients and society, with a range of outcomes. Cost-utility analysis comparing health and social care costs with quality-adjusted life-years (QALYs).
The mean cost of CBT per participant was £910. The difference in QALY gain between the groups was 0.057, equivalent to 21 days a year of good health. The incremental cost-effectiveness ratio was £14 911 (representing a 74% probability of the intervention being cost-effective at the National Institute of Health and Care Excellence threshold of £20 000 per QALY). Loss of earnings and productivity costs were substantial but there was no evidence of a difference between intervention and control groups.
The addition of CBT to usual care is cost-effective in patients who have not responded to antidepressants. Primary care physicians should therefore be encouraged to refer such individuals for CBT.
Recognition plays a multifaceted role in international theory. In rarely communicating literatures, the term is invoked to explain creation of new states and international structures; policy choices by state and non-state actors; and normative justifiability, or lack thereof, of foreign and international politics. The purpose of this symposium is to open new possibilities for imagining and studying recognition in international politics by drawing together different strands of research in this area. More specifically, the forum brings new attention to controversies on the creation of states, which has traditionally been a preserve for discussion in International Law, by invoking social theories of recognition that have developed as part of International Relations more recently. It is suggested that broadening imagination across legal and social approaches to recognition provides the resources needed for theories with this object to be of maximal relevance to political practice.
CuInS2 (chalcopyrite structure) thin films were synthesized at 250°C using a two-stage process consisting firstly in the co-evaporation of a large grain In2S3 (defect spinel structure) precursor layer followed by the addition of copper and sulfur. The crystalline properties of the resulting films are similar to those leading to high efficiency solar cells. An energy conversion efficiency of 6.7% has been attained with a 1.5 μm thick CuInS2 layer and a standard CdS buffer layer/ZnO window structure. Improved performances can be expected through the growth of thicker absorbers.
This chapter describes the different surgical procedures for managing a neurogenic bladder. The procedures include electrical stimulation, bladder and urethral reconstructive surgery, bladder outlet obstruction management and the treatment of stress urinary incontinence. Electrical stimulation to manage bladder dysfunction in patients with neurological disorders has been used since 1950. Electrical stimulation therapies include intravesical electrostimulation, sacral neuromodulation and sacral anterior root stimulation with selective sacral rhizotomy. Cutaneous continent diversions may be performed in neurological patients, mainly in the young myelomeningocele patient or those with spinal cord injury (SCI) who cannot perform clean intermittent self-catheterization (CISC) via the urethra because of congenital abnormalities, urethral pain, obesity, strictures or poor hand mobility. Finally, the chapter describes the suprapubic catheter (SPC), and sphincter surgery, which relieves bladder outlet obstruction due to external urethral sphincter contraction.
There are a number of neurological diseases which have an effect on bowel function. This chapter provides an overview of gastrointestinal (GI) physiology, with reference to the hindgut and pelvic floor. It addresses the problems caused by common neurological diseases. The intra-abdominal GI tract is varied, and divided into the organs of stomach, small intestine and large intestine. Bowel dysfunction affects approximately 80% of those with spinal cord injury (SCI) and causes more of a problem than urinary and sexual dysfunction in a third of individuals with SCI. Neurological diseases such as SCI or MS frequently impair CNS control of the gut. The difference between the neural control systems for bowel and bladder is underlined by the differing effects of such diseases on the two systems. Supraconal SCI tends to cause difficulty with evacuation of feces in addition to fecal incontinence, but predominantly difficulty with urinary continence.