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Clozapine is the antipsychotic medication with the greatest efficacy in treatment-resistant schizophrenia (TRS). Unfortunately, clozapine is ceased in approximately 0.2% to 8.5% of people due to concerns about clozapine-associated myocarditis (CAM). The opportunity for clozapine rechallenge is important for people with TRS and CAM, due to limited alternative treatments. However, there is a lack of consensus regarding the optimal process, monitoring, and dose titration to achieve successful clozapine rechallenge. The study aimed to review the process, monitoring, and dose titration within cases of clozapine rechallenge after CAM, to identify features associated with successful rechallenge.
Methods
A systematic review of clozapine rechallenge cases following CAM was conducted. PubMed, EMBASE, Cinahl, and PsycINFO were searched for cases. Reference lists of retrieved articles and field experts were consulted to identify additional studies.
Results
Forty-five cases were identified that described clozapine rechallenge, 31 of which were successful. Successful rechallenge cases generally used a slower dose titration regime with more frequent monitoring than standard clozapine initiation protocols; however, this data was not always completely recorded within cases. Six cases referred to published rechallenge protocols to guide their rechallenge.
Conclusions
The process, monitoring, and dose titration of clozapine rechallenge are inconsistently reported in the literature. Despite this, 69% of case reports detailed a successful rechallenge post CAM; noting limitations associated with reliance on case data. Ensuring published clozapine rechallenge cases report standardised data, including titration speed and monitoring frequencies, is required to guide the development and validation of guidelines for clozapine rechallenge.
Non-native plants negatively impact ecosystems via a variety of mechanisms, including in forested riparian areas. Japanese knotweed [Polygonum cuspidatum Siebold & Zucc.] and its hybrids (referred to as Polygonum spp. hereafter) are widely spread throughout North America and can impact flora and fauna of riparian habitats. Thus, information improving our ability to understand and predict the potential spread and colonization of Polygonum spp. is valuable. One dispersal mechanism is hydrochory (i.e., dispersal by water), including the downstream dispersal of viable stems that can facilitate rapid invasion within a watershed. We used passive integrated transponder (PIT) telemetry in experimental releases of Polygonum spp. stems to track the downstream transport of Polygonum spp. in a small (second-order) stream in northern New Hampshire, USA, in the summers of 2021 and 2022. A total of 180 (90 each year) Polygonum spp. stems were released at three sites within the stream reach, with 185 (∼98%) being recaptured at least once, with a total of 686 recaptures. Individual relocated stems moved a maximum distance of 30 to 875 m downstream in 2021 and 13 to 1,233 m in 2022 during regular flows; however, a high-streamflow event in July 2021 flushed out all remaining stems downstream of the study area. Generalized additive mixed models (GAMMs) identified site-specific differences in stem movement rates and a general reduction in movement rates with increased duration of time elapsed since post-release. In general, Polygonum spp. stems moved farther downstream in sites with lower channel sinuosity, although other fine-scale habitat factors (e.g., water depth, habitat type, and presence of wood and debris jams) likely contribute to the ability for Polygonum spp. to further disperse or otherwise be retained within the channel. Thus, stream morphology and stream flow are likely to affect where Polygonum spp. stems will be retained and potentially reestablish. Predictive tools identifying areas of higher probability of hydrochory-based dispersal could help to focus removal efforts when employed or to identify riparian habitats at highest risk for spread.
We propose a novel and unified sampling scheme, called the accelerated group sequential sampling scheme, which incorporates four different types of sampling scheme: (i) the classic Anscombe–Chow–Robbins purely sequential sampling scheme; (ii) the accelerated sequential sampling scheme; (iii) the relatively new k-at-a-time group sequential sampling scheme; and (iv) the new k-at-a-time accelerated group sequential sampling scheme. The first-order and second-order properties of this unified sequential sampling scheme are fully investigated with two illustrations on minimum risk point estimation for the mean of a normal distribution and on bounded variance point estimation for the location parameter of a negative exponential distribution. We also provide extensive Monte Carlo simulation studies and real data analyses for each illustration.
To describe the economic, lifestyle and nutritional impact of the COVID-19 pandemic on parents, guardians and children in Malaysia, Indonesia, Thailand and Vietnam.
Design:
Data from the SEANUTS II cohort were used. Questionnaires, including a COVID-19 questionnaire, were used to study the impact of the pandemic on parents/guardians and their children with respect to work status, household expenditures and children’s dietary intake and lifestyle behaviours.
Setting:
Data were collected in Malaysia, Indonesia, Thailand and Vietnam between May 2019 and April 2021.
Participants:
In total, 9203 children, aged 0·5–12·9 years, including their parents/guardians.
Results:
Children and their families were significantly affected by the pandemic. Although the impact of lockdown measures on children’s food intake has been relatively mild in all countries, food security was negatively impacted, especially in Indonesia. Surprisingly, in Malaysia, lockdown resulted in overall healthier dietary patterns with more basic food groups and less discretionary foods. Consumption of milk/dairy products, however, decreased. In the other countries, intake of most food groups did not change much during lockdown for households based on self-reporting. Only in rural Thailand, some marginal decreases in food intakes during lockdown persisted after lockdown. Physical activity of children, monthly household income and job security of the parents/guardians were negatively affected in all countries due to the pandemic.
Conclusion:
The COVID-19 pandemic has significantly impacted societies in South-East Asia. To counteract negative effects, economic measures should be combined with strategies to promote physical activity and eating nutrient-adequate diets to increase resilience of the population.
Tape rolls are often used for multiple patients despite recommendations by manufacturers for single-patient use. We developed a survey to query Health Care Personnel about their tape use practices and beliefs and uncovered behaviors that put patients at risk for hospital-acquired infections due to tape use.
The modern history of Tianjin, a northern port city in China, offers an intriguing urban case for scholars interested in comparative colonial practices. From the 1860s to the 1940s, Tianjin was home to up to nine foreign concessions and a sequence of different Chinese municipalities. While much scholarship on colonial history has focused on the interactive dynamics between the colonizer and the colonized, Tianjin’s colonial past draws attention to the multiplicity, multilateralism and multilayered trajectories at the heart of the colonial experiences of both imperialist powers and the Chinese. At the heart of this short survey are some reflections on the multi-imperial dimensions of the city of Tianjin. It also explains how the multi-imperial dimensions operated in Tianjin in its treaty-port incarnation and offers some considerations of how the Tianjin case contributes to broader historiographical conversations germane to the imperial–global–urban complex.
Investigations of stable carbon isotope composition in α-cellulose extracted from tree rings of pines (Pinus sylvestris L.) growing in the unpolluted Suwałki region, northeastern part of Poland, are undertaken. The presented carbon isotope record covers the period of 1931–2003. Values of δ13C measured in the tree ring α-cellulose are compared to meteorological data. These δ13C values in tree ring cellulose respond to summer temperature, insolation, relative humidity, and precipitation. The best correlation is observed between relative humidity and carbon isotope data. The August relative humidity is found more influential on δ13C values than relative humidity for any other month or combination of months (r = –0.65). Relations between isotopic and meteorological data demonstrate that precipitation influences the stable carbon isotopic ratios to a lower extent than humidity. The intensity and duration of summer rainfall events can determine this effect. The temporal stability of climate-proxy connections is an important issue in paleoclimatic reconstruction. Therefore, the temporal stability of climatic signals recorded by stable carbon isotopes is analyzed in this research using the moving correlation function for moving intervals with a 25-year window. Based on those investigations the highest time stability of correlation was found for the carbon isotope and the August relative humidity. More variability is observed for the correlation of δ13C values with precipitation.
This paper examines the role of offshoring in the flattening of the ratio of female to male hours worked in the US since the early 1990s. The observed flattening coincides with a decline in the share of occupations with high offshoring potential in women’s hours worked and an increase in service offshoring. I propose a two-gender, two-sector model with a continuum of occupations. Given the higher female intensity in the service sector, the gender hours ratio declines as service offshoring increases. Quantitatively, the service offshoring plays an important role in explaining the plateau in the gender hours ratio since the 1990s.
Cognitive therapy for PTSD (CT-PTSD) is an efficacious treatment for children and adolescents with post-traumatic stress disorder (PTSD) following single incident trauma, but there is a lack of evidence relating to this approach for youth with PTSD following exposure to multiple traumatic experiences.
Aims:
To assess the safety, acceptability and feasibility of CT-PTSD for youth following multiple trauma, and obtain a preliminary estimate of its pre–post effect size.
Method:
Nine children and adolescents (aged 8–17 years) with multiple-trauma PTSD were recruited to a case series of CT-PTSD. Participants completed a structured interview and mental health questionnaires at baseline, post-treatment and 6-month follow-up, and measures of treatment credibility, therapeutic alliance, and mechanisms proposed to underpin treatment response. A developmentally adjusted algorithm for diagnosing PTSD was used.
Results:
No safety concerns or adverse effects were recorded. Suicidal ideation reduced following treatment. No participants withdrew from treatment or from the study. CT-PTSD was rated as highly credible. Participants reported strong working alliances with their therapists. Data completion was good at post-treatment (n=8), but modest at 6-month follow-up (n=6). Only two participants met criteria for PTSD (developmentally adjusted algorithm) at post-treatment. A large within-subjects treatment effect was observed post-treatment and at follow up for PTSD severity (using self-report questionnaire measures; ds>1.65) and general functioning (CGAS; ds<1.23). Participants showed reduced anxiety and depression symptoms at post-treatment and follow-up (RCADS-C; ds>.57).
Conclusions:
These findings suggest that CT-PTSD is a safe, acceptable and feasible treatment for children with multiple-trauma PTSD, which warrants further evaluation.
This study explored the prospective use of the Ages and Stages Questionnaires-3 in follow-up after cardiac surgery.
Materials and Method:
For children undergoing cardiac surgery at 5 United Kingdom centres, the Ages and Stages Questionnaires-3 were administered 6 months and 2 years later, with an outcome based on pre-defined cut-points: Red = 1 or more domain scores >2 standard deviations below the normative mean, Amber = 1 or more domain scores 1–2 standard deviations below the normal range based on the manual, Green = scores within the normal range based on the manual.
Results:
From a cohort of 554 children <60 months old at surgery, 306 participated in the postoperative assessment: 117 (38.3%) were scored as Green, 57 (18.6%) as Amber, and 132 (43.1%) as Red. Children aged 6 months at first assessment (neonatal surgery) were likely to score Red (113/124, 85.6%) compared to older age groups (n = 32/182, 17.6%). Considering risk factors of congenital heart complexity, univentricular status, congenital comorbidity, and child age in a logistic regression model for the outcome of Ages and Stages score Red, only younger age was significant (p < 0.001). 87 children had surgery in infancy and were reassessed as toddlers. Of these, 43 (49.2%) improved, 30 (34.5%) stayed the same, and 13 (16.1%) worsened. Improved scores were predominantly in those who had a first assessment at 6 months old.
Discussion:
The Ages and Stages Questionnaires results are most challenging to interpret in young babies of 6 months old who are affected by complex CHD.
The relation between perception and production in social meaning is often taken to be transparent, with social meaning associations learned from observations of language use. However, recent work has suggested that this relation is often more complex than previously thought. Here, we present new data comparing the social meaning of realized variable liaison in spoken French, couched within the framework of the pragmatic sociology of critique. We recall data from a recent matched guise experiment showing that listeners associate the realization of liaison with meanings like “professionalism”, specifically in social situations where efficacy and expertise are at issue. Basing ourselves on this finding, we use a production task, presenting these same social situations to amateur and professional actors. We find that our participants do not exploit the social meaning potential of variable liaison, producing liaison at lexically-determined rates on a par with previous corpus studies. We discuss this discrepancy between perception and production, which suggests that the link between the two is dependent on the linguistic variable under investigation.
This study explores the effects of World Englishes teaching practice in improving EFL learners’ self-confidence in English-speaking performance (SCIESP) with a mixed methodology design comprising both qualitative and quantitative approaches. Data were gathered through a survey with the Self-Confidence in English-speaking Performance Questionnaire, students’ reflective notes, and focus group interviews. Two teaching classes with no significant difference in self-confidence were randomly chosen as the experimental class (EC) and control class (CC). The two classes shared the same teaching implication except that the EC had four lectures on World Englishes while the CC got four lectures on English History. After one semester the research team surveyed students’ SCIESP again. The result showed a remarkable improvement in students’ SCIESP in EC than in CC. It was found that World Englishes teaching contributed significantly to increasing students’ SCIESP.
Anti-reclamation movements are common in Indonesia, but their effectiveness varies. Such movements, which oppose the infilling of coastal waters and wetlands, consistently draw support from environmentalists, fisherfolk, and coastal residents. To succeed, however, they must transcend these constituencies and mobilize broad coalitions. In this paper, I apply the concept of political opportunity to explain variation in the ability of anti-reclamation movements to achieve this goal. Specifically, I argue that the opportunity to build broad coalitions depends on the positioning of political, economic, and communal elites. Disagreement among these groups creates opportunities for activists to recruit some of them as allies in the construction of economically diverse, cross-class coalitions. Consensus, by contrast, excludes elites as potential allies, forcing activists to build geographically expansive but class-based coalitions. To develop my argument, I draw on local news archives and primary source documents to compare similarly situated anti-reclamation movements in Bali and Makassar. In Bali, the movement flourished by cultivating an alliance with communal elites and local businesses. In Makassar, the movement withered because public officials, local businesses, and communal elites all welcomed reclamation. My findings imply that anti-reclamation movements are most likely to succeed when they emphasize communal identities with cross-class appeal. Yet such tactics alienate parallel movements from one another and undermine national activism. As a result, anti-reclamation movements fight the same battles over and over without achieving national reforms that would empower coastal communities to participate in coastal planning. Under such conditions, reclamation deepens the vulnerability of coastal communities to climate change.
This study investigates bacterial pathogen prevalence in daycare centers in Ile-Ife, Nigeria, highlighting significant contamination and high antibiotic resistance rates, particularly among Staphylococcus aureus. Findings underscore the need for enhanced infection control measures, sanitation practices, and public health interventions to protect children’s health in resource-limited settings.
Clostridioides difficile (C. difficile) is one of the most common causes of healthcare-associated infections (HAIs). Elimination of C. difficile spores is difficult as they are resistant to common hospital-grade disinfectants. Copper-impregnated surfaces provide continuous reduction of multiple pathogens, potentially lowering the risk of infections. This manuscript aims to evaluate the efficacy of copper-impregnated surfaces on C. difficile spores.
Methods:
Control (no copper) coupons and copper coupons containing 20% copper-oxide were inoculated with C. difficile spore loads ranging from 105 to 107 spores, with or without 5% fetal bovine serum soil load. After 4 hours of contact time, the C. difficile spores were recovered, plated on C. difficile growth media, and colony forming units were counted. The efficacy of copper (log10 kill) was estimated using a Bayesian latent variables model.
Results:
After 4 hours, unsoiled copper bedrail and copper table coupons at mean spore inoculation resulted in a 97.3% and 96.8% reduction in spore count (1.57 and 1.50 log10 kill, respectively). That of soiled bedrail and table coupons showed a 91.8% and 91.7% reduction (1.10 and 1.10 log10 kill, respectively).
Conclusions:
Copper coupons can substantially reduce C. difficile spores after 4 hours, but results vary depending on the initial spore concentration and presence or absence of organic material. Higher initial spore loads or excess organic material may prevent spores from contact with copper surfaces, thus decreasing kill efficacy. Continuous sporicidal effect of copper-impregnated surfaces may decrease spore burden and help prevent transmission of spores.