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 firstname.lastname@example.org
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.
Acute cannabis administration can produce transient psychotic-like effects in healthy individuals. However, the mechanisms through which this occurs and which factors predict vulnerability remain unclear. We investigate whether cannabis inhalation leads to psychotic-like symptoms and speech illusion; and whether cannabidiol (CBD) blunts such effects (study 1) and adolescence heightens such effects (study 2).
Two double-blind placebo-controlled studies, assessing speech illusion in a white noise task, and psychotic-like symptoms on the Psychotomimetic States Inventory (PSI). Study 1 compared effects of Cann-CBD (cannabis containing Δ-9-tetrahydrocannabinol (THC) and negligible levels of CBD) with Cann+CBD (cannabis containing THC and CBD) in 17 adults. Study 2 compared effects of Cann-CBD in 20 adolescents and 20 adults. All participants were healthy individuals who currently used cannabis.
In study 1, relative to placebo, both Cann-CBD and Cann+CBD increased PSI scores but not speech illusion. No differences between Cann-CBD and Cann+CBD emerged. In study 2, relative to placebo, Cann-CBD increased PSI scores and incidence of speech illusion, with the odds of experiencing speech illusion 3.1 (95% CIs 1.3–7.2) times higher after Cann-CBD. No age group differences were found for speech illusion, but adults showed heightened effects on the PSI.
Inhalation of cannabis reliably increases psychotic-like symptoms in healthy cannabis users and may increase the incidence of speech illusion. CBD did not influence psychotic-like effects of cannabis. Adolescents may be less vulnerable to acute psychotic-like effects of cannabis than adults.
Smoking prevalence is higher amongst individuals with schizophrenia and depression compared with the general population. Mendelian randomisation (MR) can examine whether this association is causal using genetic variants identified in genome-wide association studies (GWAS).
We conducted two-sample MR to explore the bi-directional effects of smoking on schizophrenia and depression. For smoking behaviour, we used (1) smoking initiation GWAS from the GSCAN consortium and (2) we conducted our own GWAS of lifetime smoking behaviour (which captures smoking duration, heaviness and cessation) in a sample of 462690 individuals from the UK Biobank. We validated this instrument using positive control outcomes (e.g. lung cancer). For schizophrenia and depression we used GWAS from the PGC consortium.
There was strong evidence to suggest smoking is a risk factor for both schizophrenia (odds ratio (OR) 2.27, 95% confidence interval (CI) 1.67–3.08, p < 0.001) and depression (OR 1.99, 95% CI 1.71–2.32, p < 0.001). Results were consistent across both lifetime smoking and smoking initiation. We found some evidence that genetic liability to depression increases smoking (β = 0.091, 95% CI 0.027–0.155, p = 0.005) but evidence was mixed for schizophrenia (β = 0.022, 95% CI 0.005–0.038, p = 0.009) with very weak evidence for an effect on smoking initiation.
These findings suggest that the association between smoking, schizophrenia and depression is due, at least in part, to a causal effect of smoking, providing further evidence for the detrimental consequences of smoking on mental health.
Objectives: To consider the strategies currently used by family care givers to manage challenging behaviour in the community following ABI, and to identify what supports are available that support family care givers in addressing this issue.
Research design: Delphi study.
Methods: Service providers (n = 8) and family care givers (n = 3) completed a three-round Delphi process with the aim of reaching consensus (75% agreement) regarding research objectives. Round 1 consisted of an open-ended questionnaire in which items were identified; these items were then rated in Round 2 and 3 using a Likert scale. Statistical aggregation then allowed for quantitative analysis.
Results: The findings suggest a number of behaviour management approaches are being used by family care givers, including basic antecedent strategies, agreeing with the person's demands, and medication. Consensus was reached that only two services in SA provide specific support to family care givers regarding behaviour management in the community: Families4Families Inc. (a peer support network) and Private Specialists (e.g., [neuro]psychologists and [neuro]psychiatrists).
Conclusions: Findings emphasise the need for more specialised services specific to educating and supporting family care givers in the management of challenging behaviours following ABI. These services should be accessible, centralised, and easy for family care givers to navigate.
Architectural representation – concerned as it is with things at levels of abstraction, scales of ‘bigness’, and already complex, intertwined and multi-layered contexts – often overlooks or presupposes the seemingly straightforward attributes of its engagement. Acts of looking at (or into) architectural imagery, objects and other phenomena are principally concerned with the spaces held within, rather than asking us to reflect on the experience of interacting with the representational device itself. In this way, architectural imagery attempts to mask its own presence. By always gesturing to the thing that is distant or unbuilt, it asks us, perversely, to pretend that it isn't there – that we are in fact engaging directly with the spaces and structures depicted rather than their likenesses in paper, card or otherwise. Our own practice (STASUS) and teaching concerns itself with the relationship between the observer and the architectural project, and the complex set of coded meanings which are engaged with in this encounter. We are particularly interested in the affecting nature of the space in which design processes are undertaken. In this paper, we reflect on the experience of encountering architectural projects through their representation, both in a state of completion and in process. We set out to reframe an idea of architectural design as the performance of a dialogue between recognisable, image-able things, held and staged by objects and media that don't meet or exceed expectations, but defy them, by demanding to be noticed.
This issue of arq explores how academic researchers are practicing design, and how architectural practitioners are researching design. Pedagogy has emerged as a theme bridging these two distinct subfields. Likewise, they are connected through explorations of the nature of architectural representation and process, examining how ideas, strategies, and spaces are communicated across academia and practice. The ever-changing field of architectural representation, and how we engage with it, often escapes close reading. By drawing particular attention to it, the issue aims to highlight the state of design research in the discipline today.
When readers of À la recherche come to examine Proust's correspondence, they are struck by two contradictory facts: on one hand, the considerable size of the task taken on by the editors of the letters and, on the other, the perplexing issue of the importance that might be attributed to these documents. The most extensive edition of the correspondence, completed by Philip Kolb, consists of more than five thousand letters written between 1879 and 1922 by an author who, in the last years of his life, was a total recluse and capable of writing up to eighteen letters in one day. Thanks to this outstanding editorial achievement, the importance of Proust as a letter-writer has been proven beyond doubt. Although more letters or collections of letters come to light quite regularly from various sources (Kolb was of the opinion that he had discovered perhaps only one letter in twenty) the general basis for their publication is henceforth firmly established. On the other hand, the interpretation of the letters is an area that remains largely unexplored, representing for criticism as-yet-uncharted waters.
The publication of Proust’s letters
To some extent, the publication of the letters is partly called into question by a ban imposed by the author himself. On one occasion in January 1921, Proust was returning a letter to one of his female correspondents, and expressed in the broadest terms the wish that his letters should not be preserved: ‘I insist . . . that no correspondence written by me should be preserved, let alone published’ (Corr, xx, 35). Such a statement would have carried significant implications if the novelist had followed through his decision. When questioned by myself on the subject, Philip Kolb alluded to the account given by Proust’s governess, Céleste Albaret, according to whom a lawyer who was consulted on the matter said that the novelist did not have the right to dispose as he wished of any letters he had written.
This review aims to highlight how the chronic condition self-management support (CCSMS) field might inform and enhance the skills of the disability employment services (DES) workforce, particularly in its interactions with clients with complex disability needs. The approach we have taken involves a consideration of current education and training, recruitment of staff into DES and issues of concern arising from these processes. The main findings of our review are that the current DES workforce may not have the required skills to fully meet the needs of the populations they serve given the growing burden of chronic conditions, generally. We conclude by calling for greater consideration of CCSMS education and training as core required skills for the DES workforce, so that they might integrate their practice more collaboratively alongside other support providers.
Tuberculosis (TB) is one of the most serious threats to public and individual health in Africa. In 1993, the World Health Organization (WHO) took the unprecedented step of declaring TB to be a global emergency. Since then, despite the WHO's Stop TB Strategy and significant strides taken in scaling up TB diagnostic and treatment services, control of the global TB pandemic has remained elusive. In 2008, there were an estimated 9.4 million TB cases globally and close to 1.8 million TB deaths (WHO, 2009a). Africa has the highest burden of disease per head of population, with an estimated incidence rate of 363 TB cases per 100 000. The driving force behind the African TB epidemic is the other major epidemic of human immunodeficiency virus (HIV) infection. Not only has HIV been responsible for the tremendous increase in numbers of TB cases seen in the region in the last 15 years, but it threatens TB control efforts by further stigmatizing the disease, complicating the diagnosis, reducing the effectiveness of treatment, increasing TB recurrence rates and facilitating the spread of drug-resistant disease.
In this chapter we discuss the epidemiology, pathogenesis, clinical features, diagnosis, treatment and prevention of TB, and explain how this fits together within a framework for TB control. In all these areas, we emphasize the strong link with HIV. The best chance of detecting the disease, curing the patients and halting transmission lies in having a strong countrywide TB control programme and effective collaborative activities with prevention and treatment of HIV, and we highlight how these should work.
This study examined whether starting with the behavioural component of cognitive behavioural therapy (CBT) decreases the drop-out rate in outpatients with comorbid anxiety and depression. Retrospective data were collected on 60 patients with anxiety and depression. Mean values of different psychosocial assessment scales during screening, mid-session and discharge session were compared between the patients receiving and not receiving any type of behavioural interventions and among the patients receiving different types of behavioural interventions. A significant relationship was found (p < .05) between behavioural interventions and retention in therapy. Patients who did not receive any sort of behavioural intervention showed a greater rate of drop-out than those who received behavioural interventions. In the group of patients receiving different types of behavioural interventions, there was significant improvement in mental health scores between the screening and discharge sessions in those who received exposure therapy. The study findings will be helpful to retain patients with comorbid anxiety and depression in an outpatient therapy setting. If patient retention is increased, CBT can be more effectively delivered and thereby achieve better health outcomes for patients, more effective use of therapy service resources, and decrease the socioeconomic burden of anxiety and depression on the community.
Introduction: Anxiety and depression in adolescence is prevalent but often unrecognised and untreated. This can lead to serious disorders in later life. This study explored how teachers recognise anxiety and depression in secondary school students and act on their concerns. Method: Twenty teachers from four secondary colleges in regional Victoria, Australia were interviewed regarding their experiences. In-depth interviews were analysed using descriptive thematic analysis in order to understand how teachers respond to this issue. Results: Teachers' recognition of mental health problems in students and the threshold for reporting their concerns was subjective and not based on any formal knowledge of how to identify anxiety or depression risk factors in students. Years of teaching experience was not associated with increased knowledge of mental health problems in students. Time pressures and lack of resources in student wellbeing teams were barriers to teachers reporting their concerns about students. Conclusion: Education bodies and teaching universities responsible for training teachers and providing ongoing professional learning need to ensure that mental health training is part of every teacher's core skill set, so that teachers can confidently promote mental wellbeing, identify emerging mental health problems, know how to facilitate access to more specialist intervention where required and contribute effectively to follow-up support.
The enormous burden of almost 3.6 million neonatal deaths remains relatively invisible because of gaps in data or ineffective use of existing data, the perceived complexity and expense of solutions, and societal norms for seclusion of newborns and acceptance of neonatal deaths.
The data for action for neonatal survival highlight many commonalities with maternal survival and indeed mothers and their babies are intimately linked. Stillbirths are not mentioned in Millennium Development Goal (MDG) 4 or 5, yet they are largely preventable with the same solutions. Previous false dichotomies in advocacy and programmes for maternal and newborn survival have not been helpful in accelerating progress. An integrated call for action would be more likely to increase global visibility and national action. Health professionals and policy makers need to link numbers for mothers, newborns and stillbirths together, and to work together to implement the highest impact solutions that save women and babies.
This chapter reviews the progress for MDG 4 (child survival), with a focus on neonatal survival and on highlighting linkages with MDG 5 (maternal survival). Priorities for programmatic action based on the data are identified.
Progress for neonatal and child survival
The MDGs are the most widely ratified health and development targets ever. Nearly every nation has agreed to reach these eight interlinking goals that address poverty, hunger, education and health by 2015. Multiple reports have been published and many commitments have been agreed but is progress being made?
TRIC agents do not multiply in mouse peritoneal macrophages in culture but have a toxic effect on them, whereas they multiply readily in BHK-21 cells. Sections of macrophages and of BHK-21 cells fixed during the first 90 min after inoculation were examined by electron microscopy. Macrophages ingested all forms of the organism, which were eventually degraded in lysosomes. However, elementary bodies were distinguished from other TRIC particles by the delay in their transfer to lysosomes. BHK-21 cells ingested elementary bodies selectively, and in these cells the organisms were neither found in lysosomes nor degraded. Instead they showed morphological changes that probably represented an early stage of development.
There are situations in which direct observation of the attachment of antibody molecules may be the simplest method of detecting antigen-antibody reactions. Applied to the study of the sex pili determined by a number of transmissible bacterial plasmids, the method has distinguished four serotypes in the F-like class and two in the I-like class. Antibody was usually attached haphazardly to the pili; however, in a few cases a regular periodicity could be observed. When few antibody molecules were attached, they could frequently be individually resolved and in certain antibody-pilus combinations large antibody molecules, tentatively identified as IgM, could be seen to predominate.
Mutants of Hfr strains of Escherichia coli K12 defective in conjugation owing to failure to produce sex pili were isolated by resistance to F-specific phage. Tests of the ability of six de-repressed F-like R factors and four de-repressed I-like R factors to restore Hfr donor behaviour to these mutants indicated that there were several ways in which such restoration could occur. Of a total of 26 defective mutants, 12 were restored by F-like R factors. In these twelve, the function of the integrated F factor was evidently restored, because the sex pili contained F pilin subunits, distinguishable from the R pilin by serological tests. In contrast, among the four I-like R factors, only two were effective, butin all 26 defective mutants; the restored Hfr bacteria produced only I-like pili. The I-like sex factors, in restoring Hfr donor behaviour, did not therefore act by complementing the defective F.
The kinetics of spread of colicin factor Ib (colIb) in col− cultures of S. typhimurium was studied. The rate of spread was greater with pil+ strains (those forming common pili) than with pil− strains. The difference reflects inefficient pairing between pil− cells, which donate or receive colIb efficiently only when mated with pil+ cells. The donor function of colIb is known to be repressed a few generations after it is acquired by a col− cell. While donor ability is manifest, a new type of pilus (the ‘Ib pilus’) is formed which is morphologically distinct from common pili and other sex pili such as that determined by the F factor. The Ib pilus is presumably involved in the transfer of colIb by conjugation.
The sex factor of colE1a appears related to Ib, the sex factor of colIb, by each of three criteria: mutual inhibition of epidemic spread, antigenic structure of the sex pilus and susceptibility to I phage. The failure of each factor to spread in cultures carrying the other implies that donor ability is subject to a cytoplasmic repressor. Unlike two colI factors, colE1a and colIa (or Ib) can co-exist to give a doubly colicinogenic strain.
Sexual harassment and assault on psychiatric wards is an ongoing concern. A number of incidents have been reported in the media. This paper focuses on a policy drafted to deal with allegations of sexual assault or rape on an in-patient psychiatric ward. We aimed to produce a practical, easy-to-follow guide for junior doctors and ward staff who may face complex and possibly contentious issues surrounding consent, capacity to consent and police involvement.