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.
The foci of this book are on the social determinants of health, and the importance to our health of our social connectedness and social support that turn on shared social identities. In Chapter 23, Reicher surveys these matters and makes three important concluding points. First, shared social identity in groups creates bonds between people and converts those bonds into social capital. Second, he asserts that the key to a new social model of mental and physical health lies in understanding how to support people in building and consolidating their own social groups. But, importantly, he also points out that social identity can work for good outcomes but also for those that are seen as less positive.
This chapter rounds off Section 2. In it, one of the authors, Jonathan Montgomery, begins by highlighting his view of the recurrent themes that arise from all eight chapters in this section.
Then, one of the editors, Alex Haslam, responds by substantially agreeing with Jonathan Montgomery. However, Haslam takes the opportunity to clarify one of the points that Montgomery makes with the intention of drawing attention to a key issue that runs like an artery through the body of this book. This concerns the nature of personalised healthcare and how this should best be understood and delivered. Haslam cautions that, in the process of developing personalised care, we should avoid the temptation to reduce peoples’ maladies to their individual conditions.
The Coneybury ‘Anomaly’ is an Early Neolithic pit located just south-east of Stonehenge, Wiltshire. Excavations recovered a faunal assemblage unique in its composition, consisting of both wild and domestic species, as well as large quantities of ceramics and stone tools, including a substantial proportion of blades/bladelets. We present a suite of new isotope analyses of the faunal material, together with ancient DNA sex determination, and reconsider the published faunal data to ask: What took place at Coneybury, and who was involved? We argue on the basis of multiple lines of evidence that Coneybury represents the material remains of a gathering organised by a regional community, with participants coming from different areas. One group of attendees provided deer instead of, or in addition to, cattle. We conclude that the most likely scenario is that this group comprised local hunter-gatherers who survived alongside local farmers.
While our fascination with understanding the past is sufficient to warrant an increased focus on synthesis, solutions to important problems facing modern society require understandings based on data that only archaeology can provide. Yet, even as we use public monies to collect ever-greater amounts of data, modes of research that can stimulate emergent understandings of human behavior have lagged behind. Consequently, a substantial amount of archaeological inference remains at the level of the individual project. We can more effectively leverage these data and advance our understandings of the past in ways that contribute to solutions to contemporary problems if we adapt the model pioneered by the National Center for Ecological Analysis and Synthesis to foster synthetic collaborative research in archaeology. We propose the creation of the Coalition for Archaeological Synthesis coordinated through a U.S.-based National Center for Archaeological Synthesis. The coalition will be composed of established public and private organizations that provide essential scholarly, cultural heritage, computational, educational, and public engagement infrastructure. The center would seek and administer funding to support collaborative analysis and synthesis projects executed through coalition partners. This innovative structure will enable the discipline to address key challenges facing society through evidentially based, collaborative synthetic research.
Whether monozygotic (MZ) and dizygotic (DZ) twins differ from each other in a variety of phenotypes is important for genetic twin modeling and for inferences made from twin studies in general. We analyzed whether there were differences in individual, maternal and paternal education between MZ and DZ twins in a large pooled dataset. Information was gathered on individual education for 218,362 adult twins from 27 twin cohorts (53% females; 39% MZ twins), and on maternal and paternal education for 147,315 and 143,056 twins respectively, from 28 twin cohorts (52% females; 38% MZ twins). Together, we had information on individual or parental education from 42 twin cohorts representing 19 countries. The original education classifications were transformed to education years and analyzed using linear regression models. Overall, MZ males had 0.26 (95% CI [0.21, 0.31]) years and MZ females 0.17 (95% CI [0.12, 0.21]) years longer education than DZ twins. The zygosity difference became smaller in more recent birth cohorts for both males and females. Parental education was somewhat longer for fathers of DZ twins in cohorts born in 1990–1999 (0.16 years, 95% CI [0.08, 0.25]) and 2000 or later (0.11 years, 95% CI [0.00, 0.22]), compared with fathers of MZ twins. The results show that the years of both individual and parental education are largely similar in MZ and DZ twins. We suggest that the socio-economic differences between MZ and DZ twins are so small that inferences based upon genetic modeling of twin data are not affected.
A trend toward greater body size in dizygotic (DZ) than in monozygotic (MZ) twins has been suggested by some but not all studies, and this difference may also vary by age. We analyzed zygosity differences in mean values and variances of height and body mass index (BMI) among male and female twins from infancy to old age. Data were derived from an international database of 54 twin cohorts participating in the COllaborative project of Development of Anthropometrical measures in Twins (CODATwins), and included 842,951 height and BMI measurements from twins aged 1 to 102 years. The results showed that DZ twins were consistently taller than MZ twins, with differences of up to 2.0 cm in childhood and adolescence and up to 0.9 cm in adulthood. Similarly, a greater mean BMI of up to 0.3 kg/m2 in childhood and adolescence and up to 0.2 kg/m2 in adulthood was observed in DZ twins, although the pattern was less consistent. DZ twins presented up to 1.7% greater height and 1.9% greater BMI than MZ twins; these percentage differences were largest in middle and late childhood and decreased with age in both sexes. The variance of height was similar in MZ and DZ twins at most ages. In contrast, the variance of BMI was significantly higher in DZ than in MZ twins, particularly in childhood. In conclusion, DZ twins were generally taller and had greater BMI than MZ twins, but the differences decreased with age in both sexes.
For over 100 years, the genetics of human anthropometric traits has attracted scientific interest. In particular, height and body mass index (BMI, calculated as kg/m2) have been under intensive genetic research. However, it is still largely unknown whether and how heritability estimates vary between human populations. Opportunities to address this question have increased recently because of the establishment of many new twin cohorts and the increasing accumulation of data in established twin cohorts. We started a new research project to analyze systematically (1) the variation of heritability estimates of height, BMI and their trajectories over the life course between birth cohorts, ethnicities and countries, and (2) to study the effects of birth-related factors, education and smoking on these anthropometric traits and whether these effects vary between twin cohorts. We identified 67 twin projects, including both monozygotic (MZ) and dizygotic (DZ) twins, using various sources. We asked for individual level data on height and weight including repeated measurements, birth related traits, background variables, education and smoking. By the end of 2014, 48 projects participated. Together, we have 893,458 height and weight measures (52% females) from 434,723 twin individuals, including 201,192 complete twin pairs (40% monozygotic, 40% same-sex dizygotic and 20% opposite-sex dizygotic) representing 22 countries. This project demonstrates that large-scale international twin studies are feasible and can promote the use of existing data for novel research purposes.
Painful physical symptoms (PPS) are prevalent among elderly patients with depression. We describe the impact of PPS on depression outcomes and quality of life (QOL) of elderly Asian patients with major depressive disorder (MDD).
This post hoc analysis of data from a three-month prospective observational study of East Asian MDD in- or out-patients focused on elderly patients aged ≥60 years. Depression severity was evaluated using the Hamilton depression (HAMD-17) and clinical global impression of severity (CGI-S) scales, while QOL was measured using EuroQOL (EQ-5D and EQ-VAS) instruments. PPS were rated using the modified somatic symptom inventory (SSI).
At baseline, depression was moderate to severe and 49% of the 146 elderly patients were painful physical symptom positive (PPS+). Bivariate analysis showed significant correlations between PPS and depression severity and QOL at baseline. Linear regression models showed the baseline factor most significantly associated with depression severity at three months was baseline PPS status. PPS+ patients had a mean increase of 2.87 points in their HAMD-17 rating and 0.77 points in their CGI-S score. Response and remission were significantly lower in PPS+ patients; response was 60% and remission was 40% in PPS+ patients while 82% and 66% in painful physical symptom negative (PPS−) patients. QOL at endpoint was lower in PPS+ patients.
PPS are common in elderly Asian patients with MDD and negatively influence depression outcomes and QOL. Patients with PPS had lower QOL at baseline, lower response and remission rates, higher severity of depression, and lower QOL after three months of treatment.
Post hoc analyses were conducted to evaluate the efficacy of levomilnacipran extended-release (ER) in subgroups of patients with major depressive disorder (MDD).
Data were pooled from 5 completed Phase II/III studies. Patients were categorized by sex, age, MDD duration, recurrence of MDD, current episode duration, number of prior episodes, and baseline Montgomery–Åsberg Depression Rating Scale (MADRS) score. Efficacy was evaluated by MADRS least squares (LS) mean change from baseline, response (MADRS improvement ≥50%), and remission (MADRS ≤10).
In the pooled population, treatment with levomilnacipran ER versus placebo resulted in greater improvement in MADRS score (−15.8 versus −12.9; LS mean difference, −2.9; P < .001) and higher response rates (44.7% versus 34.5%; P < .001). Comparable treatment effects were found in most subgroups. Remission rates in the overall population were higher for levomilnacipran ER versus placebo (27.7% versus 21.5%; P < .05); notably high remission rates were seen in patients with baseline MADRS score < 30 (48.8% versus 28.9%; P < .001).
Clinically meaningful improvements in depressive symptoms were found across subgroups, including statistically significant outcomes for both response and remission.
Levomilnacipran ER was efficacious across a wide range of MDD patients, including men and women, ages 18–78, with varying histories and symptom severity.
A method for determining the sex of live adult Laricobius nigrinus Fender (Coleoptera: Derodontidae) is described. Beetles were briefly chilled and positioned ventral-side-up under a dissecting microscope. Two forceps with blunted ends were used to gently brace the beetle and press on the centre of the abdomen to extrude its terminal segments. Male beetles were distinguished by a sclerotised, reticulate ninth abdominal sternite. In females, the distinct ovipositor (tergite, valvifers (ninth sternite), and laterotergites of the ninth abdominal segment) was visible. The procedure was rapid and harmed only a small number of individuals (fewer than 5%).
Emergency Medical Services (EMS) have taken great strides toward the development of city and statewide programs. However, once a person embarks on a plane or on a ship for any extended period of time, the EMS are at times meager and at other times not coordinated well with ground EMS. The American Heart Association has developed a protocol for basic and advanced cardiac life support to exist in all major air terminals, and especially within aircraft of all types. Particularly important are those aircrafts carrying large numbers of people for extended periods of time.
Recent studies have proposed the existence of three distinct subgroups of bipolar 1 disorder based on age at onset (AAO). The present study aims to investigate potential clinical and functional differences between these subgroups in an Australian sample.
Participants (n = 239) were enrolled in the Bipolar Comprehensive Outcomes Study (BCOS), a 2-year longitudinal, observational, cross-sectional study. Assessment measures included the Young Mania Rating Scale (YMRS), Hamilton Depression Rating Scale (HAMD21), Clinical Global Impressions Scale (CGI-BP), SF-36, SLICE/Life Scale, and the EuroQol (EQ-5D). Participants were also asked about their age at the first major affective episode.
Three AAO groups were compared: early (AAO < 20, mean = 15.5 ± 2.72; 44.4% of the participants); intermediate (AAO 20–39, mean = 26.1 ± 4.8; 48.14% of the participants) and late (AAO > 40, mean = 50.6 ± 9.04; 7.4% of the participants). Higher rates of depression, suicidal ideation and binge drinking were reported by the early AAO group. This group also reported poorer quality of life in a number of areas. The early AAO group had a predominant depressive initial polarity and the intermediate group had a manic predominance.
It is shown numerically, both for the two-dimensional Navier-Stokes (guidingcentre plasma) equations and for two-dimensional magnetohydrodynamics, that the long-time asymptotic state in a forced inverse-cascade situation is one in which the spectrum is completely dominated by its own fundamental. The growth continues until the fundamental is dissipatively limited by its own dissipation rate.
The Strauss equations of reduced resistive magnetohydrodynamics are solved pseudo-spectrally, inside a cylinder of square cross-section. Conducting, free-slip, boundary conditions are imposed at the boundaries normal to the direction of the imposed d.c. magnetic field and net current, and periodic boundary conditions are imposed in the third direction. The emphasis is on the development of disruptions. Initial conditions are not analytical equilibria, and are characterized by wide-band noise perturbations in many Fourier modes. Typical spatial resolution is 32 × 32 × 16. At this resolution, the code takes approximately 0·7 seconds per time step on a CRAY-1 computer. Lundquist numbers are limited by the need to resolve the small-scale turbulence which develops. Disruptions are characterized by (i) a burst of kinetic fluid activity which is roughly equipartitioned with the magnetic fluctuations at the small scales, but which involves overall kinetic energies which are much less than the magnetic energies; (ii) a helical ‘m = l, n = 1’ current filament which develops out of the wide-band turbulent noise and wraps itself around the magnetic axis; and (iii) relatively mild disturbances of the magnetic field lines, at least at these low values of Lundquist number (S ≃ 100). The results are compared with those from similar codes which solve the linearized Strauss equations.
A pseudo-spectral three-dimensional Strauss-equations code is used to describe internal disruptions in a strongly magnetized, electrically-conducting fluid, with and without an externally applied, axial electric field. Rigid conducting walls form a square (x, y) boundary, and periodic boundary conditions are assumed in the axial (z) direction. Typical resolution is 64 × 64 × 32 and the maximum Lundquist number is approximately 400. The dynamics are dominated by a helical current filament which wraps itself around the axis of the cylinder; parts of this filament can sometimes become strongly negative. The ratio of turbulent kinetic energy to total poloidal magnetic energy rises from very small values to values of the order of a few hundredths, and executes ‘bounces’ as a function of time in the absence of the external electric field. In the presence of the external electric field, the first bounce is by far the largest, then the plasma settles into a non-uniform quasi-steady state characterized by a poloidal fluid velocity flow. At the large scales, this flow has the shape of a pair of counter-rotating bean-shaped vortices. The subsequent development of this fluid flow depends strongly upon whether or not a viscous term is added to the equation of motion. Inclusion of viscosity tends to damp the flow and leads to pronounced subsequent bounces suggestive of sawtooth oscillations, though the first bounce remains substantially the largest. By means of a three-mode (Lorenz-like) truncation of the Strauss equations, the evolution of the largest spatial scales alone may be examined. Some time-dependent solutions of the low-order truncation system suggest qualitative agreement with fully resolved solutions of the Strauss equations, while other solutions exhibit interesting dynamical-systems behaviour which is thus far unparalleled in the fully-resolved simulation results.
The development of anisotropy in an initially isotropie spectrum is studied numerically for two-dimensional magnetohydrodynamic turbulence. The anisotropy develops through the combined effects of an externally imposed d.c. magnetic field and viscous and resistive dissipation at high wavenumbers. The effect is most pronounced at high mechanical and magnetic Reynolds numbers. The anisotropy is greater at the higher wavenumbers.
Jerry P. Nolan, Department of Anaesthesia and Intensive Care Medicine, Royal United Hospital, Bath BA1 3NG, UK,
Douglas Chamberlain, Department of Resuscitation Medicine, School of Medicine, Cardiff University, Wales, UK,
William H. Montgomery, Department of Anesthesiology, Straub Clinic and Hospital, University of Hawaii School of Medicine, Honolulu, Hawaii, USA,
Vinay M. Nadkarni, Departments of Anesthesia, Critical Care and Pediatrics, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania, USA
Clinical guidelines aredefinedby the Institute ofMedicine in the United States as“systematically developed statements to assist practitioner and patient decisions about appropriate health care for specific clinical circumstances.” The main objective of guidelines is to improve the quality of care received by patients by closing the gap between what clinicians do and what scientific evidence supports. Guidelines provide a point of referencefor auditing performanceof clinicians or hospitals and may improve effectiveness and efficiency. The development of guidelines requires appropriate resources: expert clinicians, group process leaders, and financial support. All these statements refer to guideline development in general, but they are particularly relevant to the development of resuscitation guidelines that have existed for at least 40 years. The steps involved in the process for developing evidence-based guidelines have been outlined by the Grades of Recommendation Assessment, Development and Evaluation (GRADE) Working Group (Table 71.1).
This chapter will review the history of consensus development in resuscitation, the role of the International Liaison Committee on Resuscitation (ILCOR), the process involved in undertaking a systematic review of resuscitation science, and the writing of clinical guidelines based on a consensus of the science.
The history of international CPR consensus and guideline development
The modern approach to cardiopulmonary resuscitation (CPR) was described in the late 1950s and early 1960s. Although this was undoubtedly the birth of CPR, it was immediately realized that the challenge was to spread the word and educate healthcare workers and laypeople throughout the world. This same challenge faces us today whenever CPR guidelines are modified and updated.