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Secession was supposed to express solidarity rooted in a shared dream of Southern independence, but something was amiss. When Georgia legislators gathered in November 1860 to consider calling a state secession convention, debate in the quiet capital of Milledgeville turned cacophonous. At issue was whether Abraham Lincoln’s election was, as Thomas R. R. Cobb put it, “sufficient ground for the dissolution of the Union.” Cobb, an ardent secessionist later killed in action at Fredericksburg, answered emphatically in the affirmative. For years, he said, Northerners had attacked slavery by opposing its westward expansion, refusing to enforce the Fugitive Slave Law, admiring John Brown, and allowing abolitionists to preach their heresies. Things would only get worse under a Republican president. Lincoln could appoint antislavery zealots to federal offices in the South. He could withhold military aid during a slave revolt. He could plant abolitionists in the Supreme Court. Given these past crimes and future threats, who could counsel delay? Cobb conceded that if the issues were fleeting or superficial, like tariff rates, he would wait for Lincoln to make an overtly aggressive move. But safeguarding slavery was too important. “My friends,” exhorted Cobb, “there is danger in delay.” He urged “immediate, unconditional secession.”
This chapter explores the organizational culture of Iraq’s army between its founding in 1921 and its collapse by the time of the American invasion in 2003. During this eighty-two-year history, the organizational culture of the Iraqi Army moved from the face of a foreign occupation in the 1920s, to a political tool of internal social and political coercion, to “probably the most potent military ever wielded by an Arab government.” However, by the time American troops pulled down the statue of Saddam in Baghdad’s Firdos Square, the army’s organizational culture was but a faint echo of not only its Iran-Iraq War pinnacle but also its historic norm. Saddam’s role was the critical factor in this change. Saddam needed professional military officers competent in developing and employing a large modern armed force, but he preferred the counsel of “violent and ignorant personalities.” Saddam could never reconcile the fundamental difference between what he called tribal and civilized (or state) warfare and the professional elements of the Iraqi armed forces could not survive in his shadow.
Depression is one of the most common mental disorders in people with advanced cancer. Although cognitive–behavioural therapy (CBT) has been shown to be effective for depression in people with cancer, it is unclear whether this is the case for people with advanced cancer and depression.
We sought to determine whether CBT is more clinically effective than treatment as usual (TAU) for treating depression in people with advanced cancer (trial registration number ISRCTN07622709).
A multi-centre, parallel-group single-blind randomised controlled trial comparing TAU with CBT (plus TAU). Participants (n = 230) with advanced cancer and depression were randomly allocated to (a) up to 12 sessions of individual CBT or (b) TAU. The primary outcome measure was the Beck Depression Inventory-II (BDI-II). Secondary outcome measures included the Patient Health Questionnaire-9, the Eastern Cooperative Oncology Group Performance Status, and Satisfaction with Care.
Multilevel modelling, including complier-average intention-to-treat analysis, found no benefit of CBT. CBT delivery was proficient, but there was no treatment effect (−0.84, 95% CI −2.76 to 1.08) or effects for secondary measures. Exploratory subgroup analysis suggested an effect of CBT on the BDI-II in those widowed, divorced or separated (−7.21, 95% CI −11.15 to −3.28).
UK National Institute for Health and Care Excellence (NICE) guidelines recommend CBT for treating depression. Delivery of CBT through the Improving Access to Psychological Therapies (IAPT) programme has been advocated for long-term conditions such as cancer. Although it is feasible to deliver CBT through IAPT proficiently to people with advanced cancer, this is not clinically effective. CBT for people widowed, divorced or separated needs further exploration. Alternate models of CBT delivery may yield different results.
Declaration of interest
M.S. is a member of the Health Technology Assessment General Board.
Americans are not invulnerable to factual information. They do not 'backfire'; facts do not make them less accurate. Instead, they become more accurate, even when corrections target co-partisans. Corrections of fake news yield similar results. Among Republicans, Trump's misstatements are less susceptible to corrections than identical misstatements attributed to other Republicans. While we do not observe facts affecting attitudes, multiple instances of misinformation can increase approval of the responsible politician - but corrections can reduce approval by similar amounts. While corrections do not eliminate false beliefs, they reduce the share of inaccurate beliefs among subjects in this study nearly in half.
This chapter argues for the centrality of the natural sciences in the Scottish Enlightenment. Beginning in the mid-seventeenth century, the activities of mathematical practitioners such as George Sinclair and virtuosi such as Sir Robert Sibbald laid the institutional foundations for the cultivation of natural knowledge in the Enlightenment era and incorporated the sciences of nature into Scotland s emerging public sphere. The restructuring of the Scottish universities in the decades following the Glorious Revolution enhanced the facilities for teaching and research in the sciences and, in doing so, fostered the rise of Newtonianism in Scotland. Newton’s writings inspired innovative work by Colin Maclaurin and other Scottish Newtonians across the many branches of mathematics and natural philosophy and also shaped the methods employed in the nascent ‘science of man’. The compatibility of the Newtonian system with religious belief, in turn, served to solidify the place of natural knowledge in Enlightenment culture, as did the harnessing of such knowledge to economic improvement. Even though the debate over James Hutton s theory of the earth in the 1790s challenged the alliance between science and religion, the natural sciences had by then established themselves as integral and vital components of the Scottish Enlightenment.
Despite knowing for many decades that depressive psychopathology is common in first-episode schizophrenia spectrum disorders (FES), there is limited knowledge regarding the extent and nature of such psychopathology (degree of comorbidity, caseness, severity) and its demographic, clinical, functional and treatment correlates. This study aimed to determine the pooled prevalence of depressive disorder and caseness, and the pooled mean severity of depressive symptoms, as well as the demographic, illness, functional and treatment correlates of depressive psychopathology in FES.
This systematic review, meta-analysis and meta-regression was prospectively registered (CRD42018084856) and conducted in accordance with PRISMA and MOOSE guidelines.
Forty studies comprising 4041 participants were included. The pooled prevalence of depressive disorder and caseness was 26.0% (seven samples, N = 855, 95% CI 22.1–30.3) and 43.9% (11 samples, N = 1312, 95% CI 30.3–58.4), respectively. The pooled mean percentage of maximum depressive symptom severity was 25.1 (38 samples, N = 3180, 95% CI 21.49–28.68). Correlates of depressive psychopathology were also found.
At least one-quarter of individuals with FES will experience, and therefore require treatment for, a full-threshold depressive disorder. Nearly half will experience levels of depressive symptoms that are severe enough to warrant diagnostic investigation and therefore clinical intervention – regardless of whether they actually fulfil diagnostic criteria for a depressive disorder. Depressive psychopathology is prominent in FES, manifesting not only as superimposed comorbidity, but also as an inextricable symptom domain.
Timely access to care services is crucial to support people with dementia and their family carers to live well. Carers of people with dementia (N = 390), recruited from eight countries, completed semi-structured interviews about their experiences of either accessing or not using formal care services over a 12-month period in the Access to Timely Formal Care (Actifcare) study. Participant responses were summarised using content analysis, categorised into clusters and frequencies were calculated. Less than half of the participants (42.3%) reported service use. Of those using services, 72.8 per cent reported timely access and of those not using services 67.2 per cent were satisfied with this situation. However, substantial minorities either reported access at the wrong time (27.2%), or feeling dissatisfied or mixed feelings about not accessing services (32.8%). Reasons for not using services included use not necessary yet, the carer provided support or refusal. Reasons given for using services included changes in the condition of the person with dementia, the service's ability to meet individual needs, not coping or the opportunity to access services arose. Facilitators and barriers to service use included whether participants experienced supportive professionals, the speed of the process, whether the general practitioner was helpful, participant's own proactive attitude and the quality of information received. To achieve timely support, simplified pathways to use of formal care services are needed.
The almost universally-occurring aggregated distributions of helminth burdens in host populations have major significance for parasite population ecology and evolutionary biology, but the mechanisms generating heterogeneity remain poorly understood. For the direct life cycle monogenean Discocotyle sagittata infecting rainbow trout, Oncorhynchus mykiss, variables potentially influencing aggregation can be analysed individually. This study was based at a fish farm where every host individual becomes infected by D. sagittata during each annual transmission period. Worm burdens were examined in one trout population maintained in isolation for 9 years, exposed to self-contained transmission. After this year-on-year recruitment, prevalence was 100% with intensities 10–2628, mean 576, worms per host. Parasite distribution, amongst hosts with the same age and environmental experience, was highly aggregated with variance to mean ratio 834 and negative binomial parameter, k, 0.64. The most heavily infected 20% of fish carried around 80% of the total adult parasite population. Aggregation develops within the first weeks post-infection; hosts typically carried intensities of successive age-specific cohorts that were consistent for that individual, such that heavily-infected individuals carried high numbers of all parasite age classes. Results suggest that host factors alone, operating post-infection, are sufficient to generate strongly overdispersed parasite distributions, rather than heterogeneity in exposure and initial invasion.
Dorothea Weltecke has remarked that we should not think of ecclesiastical history as a tree that grows from a single root in the Acts of the Apostles and Eusebius. As she argues, we may be better off thinking of churches as networks of individuals or as a bamboo forest, of distinct institutions planted in the same soil.1 However, as a historiography, ecclesiastical history does present itself as a single tree, to follow Weltecke’s analogy, some of whose branches withered away as they abandoned ‘orthodoxy’. Our challenge, therefore, is to write a history of the historians as image makers, emphasising their continuity with the past, while acknowledging that the raw material from which they constructed this image, often the events of their own times, forced innovation, some of it conscious and some of it unconscious.
Although behavior therapy reduces tic severity, it is unknown whether it improves co-occurring psychiatric symptoms and functional outcomes for adults with Tourette's disorder (TD). This information is essential for effective treatment planning. This study examined the effects of behavior therapy on psychiatric symptoms and functional outcomes in older adolescents and adults with TD.
A total of 122 individuals with TD or a chronic tic disorder participated in a clinical trial comparing behavior therapy to psychoeducation and supportive therapy. At baseline, posttreatment, and follow-up visits, participants completed assessments of tic severity, co-occurring symptoms (inattention, impulsiveness, hyperactivity, anger, anxiety, depression, obsessions, and compulsions), and psychosocial functioning. We compared changes in tic severity, psychiatric symptoms, and functional outcomes using repeated measure and one-way analysis of variance.
At posttreatment, participants receiving behavior therapy reported greater reductions in obsessions compared to participants in supportive therapy (
$\eta _p^2 $
= 0.04, p = 0.04). Across treatments, a positive treatment response on the Clinical Global Impression of Improvement scale was associated with a reduced disruption in family life (
$\eta _p^2 $
= 0.05, p = 0.02) and improved functioning in a parental role (
$\eta _p^2 $
= 0.37, p = 0.02). Participants who responded positively to eight sessions of behavior therapy had an improvement in tic severity (
$\eta _p^2 $
= 0.75, p < 0.001), inattention (
$\eta _p^2 $
= 0.48, p < 0.02), and functioning (
$\eta _p^2 $
= 0.39–0.42, p < 0.03–0.04) at the 6-month follow-up.
Behavior therapy has a therapeutic benefit for co-occurring obsessive symptoms in the short-term, and reduces tic severity and disability in adults with TD over time. Additional treatments may be necessary to address co-occurring symptoms and improve functional outcomes.
The study provides a comprehensive insight into how an initial receiving hospital without adequate capacity adapted to coping with a mass casualty incident after the Formosa Fun Coast Dust Explosion (FFCDE).
Data collection was via in-depth interviews with 11 key participants. This was combined with information from medical records of FFCDE patients and admission logs from the emergency department (ED) to build a detailed timeline of patients flow and ED workload changes. Process tracing analysis focused on how the ED and other units adapted to coping with the difficulties created by the patient surge.
The hospital treated 30 victims with 36.3% average total body surface area burn for over 5 hours alongside 35 non-FFCDE patients. Overwhelming demand resulted in the saturation of ED space and intensive care unit beds, exhaustion of critical materials, and near-saturation of clinicians. The hospital reconfigured human and physical resources differently from conventional drills. Graphical timelines illustrate anticipatory or reactive adaptations. The hospital’s ability to adapt was based on anticipation during uncertainty and coordination across roles and units to keep pace with varying demands.
Adapting to beyond-surge capacity incident is essential to effective disaster response. Building organizational support for effective adaptation is critical for disaster planning.
From the 1330s, alabaster was a material of status used to commemorate the elite of England. It was used initially for royal tombs (Edward II, John of Eltham, William of Hatfield, the dowager Queen Isabella and Philippa of Hainaut), bishops (John Stratford, William Eddington, Ralph of Shrewsbury, Thomas Hatfield and others) and the nobility. During the second half of the fourteenth century it became the conventional material for knights’ tombs and was occasionally also used for members of the legal profession. By and large, the merchant classes seem to have been excluded from this elite form of commemoration. Very few had effigial tombs, whether of alabaster or other any material, though some, like the merchants of Northleach, had floor brasses. A tiny group of alabaster merchants’ tombs also survives, virtually unstudied to date, so the aim here is to redress this omission. Why only those few select merchants were commemorated in alabaster is a question difficult to answer, as we shall see.
In the late medieval period social status and wealth did not necessarily go together. The average English merchant was significantly wealthier than the average knight and sometimes the nobility, but a stigma was attached to that wealth. According to the chivalric code, it was acceptable to make money through warfare, advantageous marriage or activities at court but not through commerce. Merchants and their families were in theory tainted by virtue of their activity. How much this actually mattered in practice to dowry-seeking social superiors is debatable, and not all merchants necessarily hungered after gentle status. They did behave increasingly like their social superiors, however, building stone houses, endowing religious institutions and, if sumptuary laws can be taken to arise out of actual behaviours that needed to be curbed, dressing grandly. The sumptuary laws of 1363 required merchants to have goods worth L500 in order to claim the privileges of squires and gentlemen worth only L100. The desire for distinctive commemoration after death would seem on the face of it to be consistent with the alleged social ambitions of the merchant class. Yet only a small number of merchants were commemorated in alabaster like the landed classes.
Intracranial aneurysm (IA) is an expansion of the weakened arterial wall that is often asymptomatic until rupture, resulting in subarachnoid hemorrhage. Here we describe the high prevalence of familial IA in a cohort of Newfoundland ancestry. We began to investigate the genetic etiology of IA in affected family members, as the inheritance of this disease is poorly understood.
Whole exome sequencing was completed for a cohort of 12 affected individuals from two multiplex families with a strong family history of IA. A filtering strategy was implemented to identify rare, shared variants. Filtered variants were prioritized based on validation by Sanger sequencing and segregation within the families.
In family R1352, six variants passed filtering; while in family R1256, 68 variants remained, so further filtering was pursued. Following validation by Sanger sequencing, top candidates were investigated in a set of population controls, namely, C4orf6 c.A1G (p.M1V) and SPDYE4c.C103T (p.P35S). Neither was detected in 100 Newfoundland control samples.
Rare and potentially deleterious variants were identified in both families, though incomplete segregation was identified for all filtered variants. Alternate methods of variant prioritization and broader considerations regarding the interplay of genetic and environmental factors are necessary in future studies of this disease.
In recent years, the discovery of massive quasars at
has provided a striking challenge to our understanding of the origin and growth of supermassive black holes in the early Universe. Mounting observational and theoretical evidence indicates the viability of massive seeds, formed by the collapse of supermassive stars, as a progenitor model for such early, massive accreting black holes. Although considerable progress has been made in our theoretical understanding, many questions remain regarding how (and how often) such objects may form, how they live and die, and how next generation observatories may yield new insight into the origin of these primordial titans. This review focusses on our present understanding of this remarkable formation scenario, based on the discussions held at the Monash Prato Centre from November 20 to 24, 2017, during the workshop ‘Titans of the Early Universe: The Origin of the First Supermassive Black Holes’.
The Bubog-1 rockshelter on Ilin Island has provided important evidence for Late Pleistocene to Mid-Holocene (c. 33 000–4000 cal BP) human habitation, yet little is known about the contemporaneous transmission of material culture, technology and mortuary practices across Island Southeast Asia. Recent archaeological research at Bubog-1 has revealed a tightly flexed inhumation dating to c. 5000 cal BP—a type representative of a widespread, contemporaneous burial practice observed across the region. The emergence of diverse burial practices and their spread across Island Southeast Asia coincides with evidence for technological innovation and increasing long-distance interaction between island communities.