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Deep brain stimulation (DBS) is a widely used treatment for movement disorders inadequately treated with medications, including Parkinson’s disease (PD), dystonia, and various forms of tremor. In this chapter, we focus on what has changed in the past five years in the use of DBS for PD treatment in the context of the basics. This will serve as both an update for the experienced person and a detailed text for the novice. We discuss updates on the new types of approved hardware that have allowed for even greater stimulation options, new information on management of non-motor symptoms associated with DBS, long-term prognosis and outcomes, new data on when to perform surgery, and developments shaping the future of DBS.
The climatic, hydrographic, and environmental regimes of terminal Pleistocene and Holocene northwestern Mongolia are reconstructed using archaeological and pedological data sets at Bayan Nuur, a lake on the northwestern perimeter of the Altan Els dune field in eastern Uvs Province, Mongolia. The archaeological data consist of land-use patterns controlled for time via time-sensitive, diagnostic artifacts. The pedological data consist of soil classifications and radiocarbon dating of paleosols that track lake levels and water table. These data are combined using a geographic information system (GIS) to ascertain site and paleosol geographic relationships to modern lake levels at Bayan Nuur. They point to a more xeric Younger Dryas than previously recognized, significant Holocene lake regressions, and to Mid- to Late Holocene lake standstills/transgressions, the scale of which had previously been unrecognized. Combined, these data point to a complex late Quaternary picture of paleoclimate and paleoenvironment across the region and the importance of using multiple proxies, including archaeological data, in paleoecological reconstructions.
This article reports findings from a study that sought to identify barriers to music and music education in the UK. Emerging from empirical research involving n = 723 participants and clarified by an evidence base of over 10,000 research participants, the key findings presented in this paper relate to pupil and participant voice and involvement, location as a sub-theme of diversity and inclusion, collaboration and transition points. The research is contextualised by twenty years of policy initiatives seeking to address barriers to music learning. The article provides an overview of the research study before presenting the rich data that emerged within each theme reported. Research participant voice is used as much as possible to enable the reader to consider, reflect and interpret the data in a way that is meaningful for their own context. The paper concludes by asking why after 20 years of policy initiatives, research and evaluation the same barriers still exist and, as we emerge from the pandemic, suggests that this research provides a compelling case that now is the time for change.
Drug development is a long and arduous process that requires many researchers at different types of institutions. These include researchers in university settings, researchers in government settings, researchers in non-profit organizations and researchers in the pharmaceutical industry. The pharmaceutical industry itself is heterogeneous, ranging from tiny biotech companies to large multi-national organizations. This chapte emphasizes drug development efforts by the pharmaceutical industry but will also make note of the many collaborations between pharma and researchers at other types of institutions.
Young people with social disability and severe and complex mental health problems have poor outcomes, frequently struggling with treatment access and engagement. Outcomes may be improved by enhancing care and providing targeted psychological or psychosocial intervention.
Aims
We aimed to test the hypothesis that adding social recovery therapy (SRT) to enhanced standard care (ESC) would improve social recovery compared with ESC alone.
Method
A pragmatic, assessor-masked, randomised controlled trial (PRODIGY: ISRCTN47998710) was conducted in three UK centres. Participants (n = 270) were aged 16–25 years, with persistent social disability, defined as under 30 hours of structured activity per week, social impairment for at least 6 months and severe and complex mental health problems. Participants were randomised to ESC alone or SRT plus ESC. SRT was an individual psychosocial therapy delivered over 9 months. The primary outcome was time spent in structured activity 15 months post-randomisation.
Results
We randomised 132 participants to SRT plus ESC and 138 to ESC alone. Mean weekly hours in structured activity at 15 months increased by 11.1 h for SRT plus ESC (mean 22.4, s.d. = 21.4) and 16.6 h for ESC alone (mean 27.7, s.d. = 26.5). There was no significant difference between arms; treatment effect was −4.44 (95% CI −10.19 to 1.31, P = 0.13). Missingness was consistently greater in the ESC alone arm.
Conclusions
We found no evidence for the superiority of SRT as an adjunct to ESC. Participants in both arms made large, clinically significant improvements on all outcomes. When providing comprehensive evidence-based standard care, there are no additional gains by providing specialised SRT. Optimising standard care to ensure targeted delivery of existing interventions may further improve outcomes.
British Telecom’s 1984 partial privatization set in motion the privatization and deregulation of many international state-owned telecommunications carriers. Most previous research on the privatization and deregulation of state-owned telecommunications carriers has focused on the economic outcomes. However, this was also a time of changes in managerial practice and thinking influenced by organizational theory. This article presents an analysis of the use of the prescriptions of Rosabeth Kanter in the attempted reform of the organizational culture of Australia’s largest business in the 1980s: the government-owned telecommunications monopoly Telecom Australia (now Telstra). It details the attempt to transform Telecom under the incipient threat of the introduction of competition to the telecommunications market and demonstrates how the country’s largest change management program, Vision 2000, represented an alternative approach to telecommunications reform.
Wisdom is a personality trait comprising seven components: self-reflection, pro-social behaviors, emotional regulation, acceptance of diverse perspectives, decisiveness, social advising, and spirituality. Wisdom, a potentially modifiable trait, is strongly associated with well-being. We have published a validated 28-item San Diego Wisdom Scale, the SD-WISE-28. Brief scales are necessary for use in large population-based studies and in clinical practice. The present study aimed to create an abbreviated 7-item version of the SD-WISE.
Method:
Participants included 2093 people, aged 20-82 years, recruited and surveyed through the online crowdsourcing platform Amazon Mechanical Turk. The participants’ mean age was 46 years, with 55% women. Participants completed the SD-WISE-28 as well as validation scales for various positive and negative constructs. Psychometric analyses (factor analysis and item response theory) were used to select one item from each of the seven SD-WISE-28 subscales.
Results:
We selected a combination of items that produced acceptable unidimensional model fit and good reliability (ω = 0.74). Item statistics suggested that all seven items were strong indicators of wisdom, although the association was weakest for spirituality. Analyses indicated that the 28-item and 7-item SD-WISE are both very highly correlated (r = 0.92) and produce a nearly identical pattern of correlations with demographic and validity variables.
Conclusion:
The SD-WISE-7, and its derived Jeste-Thomas Wisdom Index (JTWI) score, balances reliability and brevity for research applications.
Researchers of museum collections owe a great debt of gratitude to those responsible for curating the collections; however, staff may frequently remain innocently unaware of significant contents within the accessions. Such is a group of flint artefacts in Salisbury Museum, Wiltshire, which were found in 1860 on the outskirts of the city. The collection was rediscovered during unrelated archaeological research and comprises a series of blades, which include refitting components, demonstrating that the artefacts came from undisturbed prehistoric contexts. The blade blanks had been removed from opposed platform cores, using careful core preparation and soft hammer percussion. These characteristics can be most closely paralleled by Upper Palaeolithic Federmesser industries in Europe, which date from the end of the Last Glaciation. The existence of the Upper Palaeolithic was unrecognised at the time the artefacts were found, since when two other contemporary sites have been identified in the River Avon valley as well as others across the country. The newly recognised addition extends the distribution of Upper Palaeolithic activity further up the River Avon valley to Salisbury, where five rivers congregate, providing a convenient point for further dispersal. The finding also mirrors patterns of occupation on well-drained terrace bluffs overlooking the floodplain. Research results have yielded significant data, 160 years after the collection’s discovery, expanding current knowledge of the Upper Palaeolithic in the River Avon valley and demonstrating the continued value and potential of collections in our museums.
Technological opportunities are explored to enhance detection schemes in transmission electron microscopy (TEM) that build on the detection of single-electron scattering events across the typical spectrum of interdisciplinary applications. They range from imaging with high spatiotemporal resolution to diffraction experiments at the window to quantum mechanics, where the wave-particle dualism of single electrons is evident. At the ultimate detection limit, where isolated electrons are delivered to interact with solids, we find that the beam current dominates damage processes instead of the deposited electron charge, which can be exploited to modify electron beam-induced sample alterations. The results are explained by assuming that all electron scattering are inelastic and include phonon excitation that can hardly be distinguished from elastic electron scattering. Consequently, a coherence length and a related coherence time exist that reflect the interaction of the electron with the sample and change linearly with energy loss. Phonon excitations are of small energy (<100 meV), but they occur frequently and scale with beam current in the irradiated area, which is why we can detect their contribution to beam-induced sample alterations and damage.
This article reports on a new project to investigate the activities of early Homo sapiens in the area of the Chotts ‘megalake’ in southern Tunisia. Excavations in 2015 and 2019 at Oued el Akarit revealed one of a number of Middle Stone Age (MSA) horizons near the top of a long sequence of Upper Pleistocene deposits. The site identified as Oued el Akarit (Sondage 8) consists of lithic artefacts, bone fragments of large ungulates and pieces of ostrich eggshell. Many of the objects are burnt. Excavation of about nine square metres revealed that these were associated with a lightly trampled and combusted occupation surface. Amongst the identified artefacts were Levallois flakes some of which could be refitted, thereby indicating the generally undisturbed nature of the occupation. The lithic finds also included side scrapers and other tools diagnostic of the MSA but significantly no bifacial or tanged tools. OSL (Optically Stimulated Luminescence) dating of the sediments and AMS (Accelerator Mass Spectrometry) radiocarbon dating of ostrich eggshell have produced uncalibrated age determinations in the range 37,000–40,000 years ago, one of the youngest ages for MSA sites in the region. This is the first example of a securely dated later MSA occupation in a riparian environment in south-eastern Tunisia.
In a detailed study of the gospels of Matthew, Mark, Luke and John, Stephen Barton examines the character of God in each narrative. He shows that controversial claims about God are implied at every point in the gospel stories of Jesus, shaped as they are by an apocalyptic worldview and by the parting of the ways between the synagogue and the church.