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An interested and engaged electorate is widely believed to be an indicator of democratic health. As such, the aggregate level of political interest of an electorate – macrointerest – is an essential commodity in a democracy, and understanding the forces that change macrointerest is important for diagnosing the health of a democracy. Because being interested in politics requires time and effort, the article theorizes that the electorate's level of political interest will be highest when the electorate believes the government cannot be trusted or is performing poorly. To test hypotheses derived from a proposed theory against rival explanations, the study develops a measure of macrointerest using a quarterly time series of aggregated survey items (1973–2014) of political interest. The authors find support for the theory that the electorate responds as reasonable agents when determining how closely to monitor elected officials: interest is positively related to decreases in trust in government.
Stable isotopes of mammoths and mastodons have the potential to illuminate ecological changes in late Pleistocene landscapes and megafaunal populations as these species approached extinction. The ecological factors at play in this extinction remain unresolved, but isotopes of bone collagen (δ13C, δ15N) and tooth enamel (δ13C, δ18O, 87Sr/86Sr) from midwestern North America are leveraged to examine ecological and behavioral changes that occurred during the last interglacial-glacial cycle. Both species had significant C3 contributions to their diets and experienced increasing levels of niche overlap as they approached extinction. A subset of mastodons after the last glacial maximum exhibit low δ15N values that may represent expansion into a novel ecological niche, perhaps densely occupied by other herbivores. Stable isotopes from serial and microsampled enamel show increasing seasonality and decreasing temperatures as mammoths transitioned from Marine Isotope Stage (MIS) 5e to glacial conditions (MIS 4, MIS 3, MIS 2). Isotopic variability in enamel suggests mobility patterns and life histories have potentially large impacts on the interpretation of their stable isotope ecology. This study further refines the ecology of midwestern mammoths and mastodons demonstrating increasing seasonality and niche overlap as they responded to landscape changes in the final millennia before extinction.
This Essay examines a series of paradoxes that have rendered the international legal order's mechanisms for collective action powerless precisely when they are needed most to fight COVID-19. The “patriotism paradox” is that disengagement from the international legal order weakens rather than strengthens state sovereignty. The “border paradox” is that securing domestic populations by excluding noncitizens, in the absence of accompanying regulatory mechanisms to secure adherence to internal health measures, accelerates viral spread among citizens. The “equality paradox” is that while pandemics pose an equal threat to all people, their impacts compound existing inequalities.
Background: In June 2019, the Maryland Department of Health (MDH) was notified of a hospitalized patient with Candida auris bloodstream infection. The MDH initiated a contact investigation to identify additional patients with C. auris colonization. Many of the contacts had been discharged home from the hospital and were therefore not available for screening. Healthcare facilities in Maryland, Virginia, and Washington, DC, submit patient data to a regional health information exchange (HIE) called the Chesapeake Regional Information System for our Patients (CRISP). CRISP includes a notification system that alerts providers when flagged patients have healthcare encounters. We aimed to use this system to identify discharged C. auris contacts on their next inpatient encounter to rapidly screen them and to detect new cases. Methods:C. auris contacts were defined as patients located on an inpatient unit on the same day, receiving wound care from the same team, or having a procedure in the same operating room on the same day as the index patient or any patients subsequently identified as having C. auris infection or colonization detected either during the normal course of clinical care or through screening. Contacts who remained hospitalized were screened during inpatient point prevalence surveys (PPSs). Contacts discharged to postacute-care facilities were screened by facility staff. Contacts who had been discharged home were flagged in CRISP, and MDH staff received CRISP encounter alerts when these patients were readmitted. MDH staff then contacted the admitting facilities to recommend screening for C. auris. Axilla and groin swabs were collected and tested by rt-PCR at the Mid-Atlantic Regional Antibiotic Resistance Laboratory Network laboratory. Results: As of October 8, 2019, 4,017 contacts were identified. Among these, 936 (23%) contacts at 56 healthcare facilities (33 acute-care hospitals and 23 postacute-care facilities) were screened for C. auris, and 10 patients with C. auris colonization were identified (1.1% of contacts who underwent C. auris screening). Of these, 6 (60%) were identified through CRISP notification and 4 (40%) were identified by PPSs conducted in acute-care hospitals. Conclusions: In this ongoing C. auris outbreak, a large proportion of colonized patients was identified using an electronic encounter notification system within a regional HIE. This approach was effective for identifying opportunities to screen contacts at their next healthcare encounter and can augment other means of case detection, like PPSs. HIEs should incorporate mechanisms to facilitate contact tracing for public health investigations.
Preferences for conflict and cooperation are systematically different for men and women: across a variety of contexts, women generally prefer more peaceful options and are less supportive of making threats and initiating conflict. But how do these preferences affect states’ decisions for war and patterns of conflict at the international level, such as the democratic peace? Women have increasingly participated in political decision making over the last century because of suffragist movements. But although there is a large body of research on the democratic peace, the role of women's suffrage has gone unexplored. Drawing on theory, a meta-analysis of survey experiments in international relations, and analysis of crossnational conflict data, we show how features of women's preferences about the use of force translate into specific patterns of international conflict. When empowered by democratic institutions and suffrage, women's more pacific preferences generate a dyadic democratic peace (i.e., between democracies), as well as a monadic peace. Our analysis supports the view that the enfranchisement of women is essential for the democratic peace.
This article explores how marginalized groups navigated the everyday politics of citizenship in Britain during the Second World War through a case-study of the Sorby Research Institute in Sheffield, a site in which pacifists and conscientious objectors participated in medical experiments as an alternative to military service. Examining the experiences of volunteers who were infested with parasites in a study of infectious disease transmission, this article traces the emergence of ‘somatic citizenship’ at the SRI: a distinctive kind of wartime service that was rooted in the everyday sensations, routines, and practices of the body. Ultimately, this article argues that the somatic labours of medical research offered a way of partially reconciling the conflicting demands of pacifism and national duty, allowing volunteers to reposition themselves as heroic wartime citizens. However, this was not a straightforward path to social rehabilitation, with various political, moral, and hygienic anxieties disrupting the pursuit of community acceptance. While contributing to ongoing work on citizenship, subjectivity, and emotion in wartime Britain, these findings also demonstrate how unconventional sources – in this case, medicalized descriptions of the body – can be redeployed to illuminate the politically saturated nature of everyday life under the conditions of total war.
Substance use occurs at a high rate in persons with a psychiatric disorder. Genetically informative studies have the potential to elucidate the etiology of these phenomena. Recent developments in genome-wide association studies (GWAS) allow new avenues of investigation.
Using results of GWAS meta-analyses, we performed a factor analysis of the genetic correlation structure, a genome-wide search of shared loci, and causally informative tests for six substance use phenotypes (four smoking, one alcohol, and one cannabis use) and five psychiatric disorders (ADHD, anorexia, depression, bipolar disorder, and schizophrenia).
Two correlated externalizing and internalizing/psychosis factor were found, although model fit was beneath conventional standards. Of 458 loci reported in previous univariate GWAS of substance use and psychiatric disorders, about 50% (230 loci) were pleiotropic with additional 111 pleiotropic loci not reported from past GWAS. Of the 341 pleiotropic loci, 152 were associated with both substance use and psychiatric disorders, implicating neurodevelopment, cell morphogenesis, biological adhesion pathways, and enrichment in 13 different brain tissues. Seventy-five and 114 pleiotropic loci were specific to either psychiatric disorders or substance use phenotypes, implicating neuronal signaling pathway and clathrin-binding functions/structures, respectively. No consistent evidence for phenotypic causation was found across different Mendelian randomization methods.
Genetic etiology of substance use and psychiatric disorders is highly pleiotropic and involves shared neurodevelopmental path, neurotransmission, and intracellular trafficking. In aggregate, the patterns are not consistent with vertical pleiotropy, more likely reflecting horizontal pleiotropy or more complex forms of phenotypic causation.
Political advertising is changing. Dominic Cummings, Campaign Director for Vote Leave sums this up well in an article on how Brexit was ‘won’:
We were urged by everyone to hire a big advertising agency and do traditional posters. ‘When can we discuss our posters?’ I was asked constantly by people who would then try to explain to me their creative ideas (‘we need another Labour Isn't Working, Dominic, I’ve got an idea for a picture of the globe and arrows …’) … Instead of spending a fortune on an expensive agency (with 15% going to them out of ‘controlled expenditure’) and putting up posters to be ‘part of the national conversation’ weeks or months before the vote, we decided to … put almost all our money into digital (∼98%) … (Cummings 2017)
Facebook also advertised its own ‘success story’ with the election of the Conservative Party in the UK in 2015. The advert claims:
In a tightly contested election, the UK political party combined powerful creative [advertising] with Facebook 's targeting tools to achieve what the pollsters and media had universally predicted to be impossible: a win by outright majority.
80.6% reach in key constituencies on Facebook
3.5 million video views
86.9% of all ads served had social context
This advertisement also contains the following quote from Craig Elder, Digital Director of the Conservative Party:
The level of targeting we had available to us on Facebook – coupled with the research and data we produced internally – meant that we can say for the first time in a UK election that digital made a demonstrable difference to the final election result.
Political advertising is changing. In this chapter, I consider some of the implications of this for the democratic process.
We are now aware that Cambridge Analytica, for instance, harvested data from Facebook and used it to create targeted online political advertisements in both the Brexit vote and the 2016 US Presidential Election. This raises numerous ethical concerns, including issues of consent, privacy and respect for citizens’ data and information. These are seriously important issues, but I will not explicitly address them here. In this chapter, I focus on online political advertisements .
Although there is growing interest in mental health problems in university students there is limited understanding of the scope of need and determinants to inform intervention efforts.
To longitudinally examine the extent and persistence of mental health symptoms and the importance of psychosocial and lifestyle factors for student mental health and academic outcomes.
Undergraduates at a Canadian university were invited to complete electronic surveys at entry and completion of their first year. The baseline survey measured important distal and proximal risk factors and the follow-up assessed mental health and well-being. Surveys were linked to academic grades. Multivariable models of risk factors and mental health and academic outcomes were fit and adjusted for confounders.
In 1530 students surveyed at entry to university 28% and 33% screened positive for clinically significant depressive and anxiety symptoms respectively, which increased to 36% and 39% at the completion of first year. Over the academic year, 14% of students reported suicidal thoughts and 1.6% suicide attempts. Moreover, there was persistence and overlap in these mental health outcomes. Modifiable psychosocial and lifestyle factors at entry were associated with positive screens for mental health outcomes at completion of first year, while anxiety and depressive symptoms were associated with lower grades and university well-being.
Clinically significant mental health symptoms are common and persistent among first-year university students and have a negative impact on academic performance and well-being. A comprehensive mental health strategy that includes a whole university approach to prevention and targeted early-intervention measures and associated research is justified.
Mood instability and sleep disturbance are common symptoms in people with mental illness. Both features are clinically important and associated with poorer illness trajectories. We compared clinical outcomes in people presenting to secondary mental health care with mood instability and/or sleep disturbance with outcomes in people without either mood instability or sleep disturbance.
Data were from electronic health records of 31,391 patients ages 16–65 years presenting to secondary mental health services between 2008 and 2016. Mood instability and sleep disturbance were identified using natural language processing. Prevalence of mood instability and sleep disturbance were estimated at baseline. Incidence rate ratios were estimates for clinical outcomes including psychiatric diagnoses, prescribed medication, and hospitalization within 2-years of presentation in persons with mood instability and/or sleep disturbance compared to individuals without either symptom.
Mood instability was present in 9.58%, and sleep disturbance in 26.26% of patients within 1-month of presenting to secondary mental health services. Compared with individuals without either symptom, those with mood instability and sleep disturbance showed significantly increased incidence of prescription of any psychotropic medication (incidence rate ratios [IRR] = 7.04, 95% confidence intervals [CI] 6.53–7.59), and hospitalization (IRR = 5.32, 95% CI 5.32, 4.67–6.07) within 2-years of presentation. Incidence rates of most clinical outcomes were considerably increased among persons with both mood instability and sleep disturbance, relative to persons with only one symptom.
Mood instability and sleep disturbance are present in a wide range of mental disorders, beyond those in which they are conventionally considered to be symptoms. They are associated with poor outcomes, particularly when they occur together. The poor prognosis associated with mood instability and sleep disorder may be, in part, because they are often treated as secondary symptoms. Mood instability and sleep disturbance need better recognition as clinical targets for treatment in their own right.
The application of recovery principles within everyday mental health services is understudied.
Objectives and aims
We studied the implementation of a programme of intensive case management (ICM) emphasizing recovery principles in an Irish community mental health service.
Eighty service attenders with severe and enduring illness were randomized into groups
(1) receiving a programme of ICM,
(2) receiving treatment as usual (TAU).
Groups were compared before/after the programme for general psychopathology using the Brief psychiatric Rating Scale [BPRS] (clinician rated) and How are You? Scale (self-rated). The Functional Analysis of Care Environments [FACE] scale provided assessment of functional domains.
The overall group [mean age 44.5 ± 13.2 years; 60% male] had mean total Health of the Nation Outcome Scale [HoNOS] scale scores 10.5 ± 4.6 with impaired social functioning especially prominent (mean social subscale score 5.0 ± 2.7). The ICM group were younger (p < 0.01) with higher baseline scores on the HoNOS social subscale and BPRS (p < 0.05). An analysis of covariance, controlling for these baseline differences, indicated greater improvement in BPRS scores (p = 0.001), How are You? scores (p = 0.02) and FACE domains for cognition, symptoms and interpersonal relationships (all p < 0.001) in the ICM group. The ICM group underwent greater changes in structured daily activities that were linked to improved BPRS scores (p = 0.01).
A programme of ICM emphasizing recovery principles allowed significant improvement across psychopathological and functional domains. Improvements were linked to enhanced engagement with structured daily activities. Recovery-oriented practices can be integrated into existing mental health services and provided alongside traditional models of care.
Schizophrenia is a serious mental illness that carries a significant burden for families providing care.
The ADHES carers' survey canvassed opinions of families/friends of patients with schizophrenia across Europe.
To ascertain carer attitudes towards schizophrenia, its treatment and treatment adherence.
The survey was conducted from January-April 2011 in 16 European countries, comprising 10 questions relating to the respondents' understanding of schizophrenia, attitudes towards schizophrenia treatments, and perception of the family's/friend's role in supporting patients with schizophrenia.
Results were obtained from 138 respondents. 76% of carers recognized the importance of medication to help patients get better, improve their quality of life (77%) and relationships (74%). 67% of carers responded that they believed schizophrenia treatment damages patients' general health. Two-thirds of the carers reported that treatment adherence was a burden for the patient and over a third of carers indicated that it was a daily struggle to get patients to take their medication. 50% of carers considered the benefits offered by long-acting injectable antipsychotics as very/quite important and thus, could provide a valuable tool in improving treatment adherence. 92% of carers agreed on the importance of family support to boost treatment adherence with education/information deemed important for families and patients alike.
Carers recognize the issues they face in caring for patients with schizophrenia and their role in improving partial/non-adherence to medication, especially to avoid suboptimal treatment outcomes. The important role of family carers should be considered by healthcare professionals when treating patients with schizophrenia.
Behavioral genetic research unequivocally supports the influence of both genetic and environmental factors on psychopathology risk. Decomposition of the sources of these influences has largely been carried out using twin and adoption studies. Building off the results of these studies, molecular genetic methodologies have come to dominate the field with the goal of identifying genetic variants that causally influence psychopathology risk. The chapter summarizes the logic of both quantitative and molecular genetic methods as well as their major findings as related to clinical psychology. Traditional and modern methods for estimating heritability based on familial relationships are described. From there the challenge of finding causal genetic variants in the context of polygenic phenotypes, including psychopathology, emerges. The chapter concludes by discussing the interaction between genes and the environment as well as future directions in the field, including rare variant analysis and epigenetics. An emphasis is placed on interpretation of results and limitations of past and current methodologies. Behavioral genetic research has produced strong results regarding the importance of genetic factors on psychopathology while also highlighting the influence of the environment. Uncovering the causal sources of these effects remains a young but active area of research.
The Channel crossings in Ford Madox Ford's biography are complex. His grandfather, Ford Madox Brown, was born in France and studied in Belgium. Ford's father was a German who studied Provençale and emigrated to Britain. During the First World War, Ford wrote propaganda books triangulating English, French and German culture. After returning from the Western Front, he emigrated to France. A primary emphasis of this essay will be how his formative collaboration with Joseph Conrad reinforced an ideal of the conscious artistry of French fiction (exemplified by Stendhal, Flaubert and Maupassant). Ford was delighted when The Good Soldier was described by a publisher friend, John Rodker, as ‘the finest French novel in the English language’ (Ford 1927: 5). The essay will explore how Ford's own work bears out his injunction to translate English sentences into French and then back into English as a means of clarifying and purifying them. This reverberation of languages, people and texts across the Channel will be shown to be constitutive of Ford's version of Impressionism in literature. However, the essay will also argue that the transmanche is always doubled, for Ford, by the transatlantic. American writers living in Britain and Europe, from Henry James and Stephen Crane at the turn of the century, to Ezra Pound in Edwardian London, and Gertrude Stein and Ernest Hemingway in Paris in the 1920s, themselves mostly saturated with continental literature and art, continually contributed to the development of Ford's Impressionism and modernity. The conclusion will suggest that Ford's cultural internationalism – his belief in a ‘Republic of Letters’ – crosses all borders, foreshadowing recent discussions of global modernism and of world literature – nowhere more so than in his last, immense and inclusive comparative study The March of Literature (1938).
The cosmopolitanism of Ford's heritage has been dealt with often enough to require only brief rehearsing here. His father's family, the Hüffers, were well established in France, Italy and the Netherlands as well as Germany. One had gone into tobacco in the United States. Franz Hüffer, Ford's father, was a free-thinking Schopenhauerian who championed Wagner, and ended up as music critic for The Times.
Methamphetamine has been consistently associated with positive psychotic symptoms, but little is known about whether the reverse also occurs.
This study determined whether the relationship between methamphetamine use and positive psychotic symptoms is bidirectional over 12 months. The impact of lifetime psychotic disorders and methamphetamine dependence on these relationships was also examined.
A total of 201 regular (at least monthly) primary methamphetamine users were recruited from free needle and syringe programmes in three Australian cities. Data on the frequency of methamphetamine and other drug use (from Timeline Followback inteviews) and the severity of positive psychotic symptoms (using the Brief Psychiatric Rating Scale) in the past 2 weeks were collected in 12 contiguous monthly face-to-face interviews (mean of 9.14/11 (s.d. = 3.16) follow-ups completed). Diagnoses were derived using the Psychiatric Research Interview for DSM-IV Substance and Mental Disorders.
The mean age of participants was 31.71 years (s.d. = 8.19) and 39% (n = 77) were women. At baseline 55% (n = 110) were dependent on methamphetamine and 51% (n = 102) had a lifetime psychotic disorder. Cross-lagged dynamic panel models found a significant bidirectional relationship between psychotic symptoms and methamphetamine use (Comparative Fit Index (CFI) = 0.94, standardised root mean square residual (SRMR) = 0.05, root mean square error of approximation (RMSEA) = 0.05, 95% CI 0.04–0.06). The magnitude of the relationship in each direction was similar, and the presence of methamphetamine dependence or a lifetime psychotic disorder did not have an impact on results.
A dynamic, bidirectional relationship between methamphetamine and psychotic symptoms of similar magnitude in each direction was found over 1 year. This suggests integrated treatments that target methamphetamine, psychotic symptoms and their interrelationship may be of most benefit.