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Are you or someone you know struggling with hoarding disorder, feeling ashamed or guilty about your belongings, and afraid to let them go? It's more common than you might think, affecting up to 6% of the general population. But despite its prevalence, seeking help can be challenging. This new book provides a clear description of hoarding, exploring it as a symptom of other issues as well as a condition in its own right. You'll learn about different treatment options and find step-by-step guidance and tools for recovery in the self-help section. Personal narratives and case studies make this guide accessible and relatable for those affected by hoarding, as well as their loved ones and health professionals. Don't let hoarding disorder control your life - take the first step towards recovery today with this invaluable resource.
This article considers modular composition as an approach to engendering structural plasticity in musical works. Structural plasticity, in this case, is defined as the ability for the components of a musical work (e.g., events, ideas, sequences, textures, timbres) to vary in how and when they are presented. In this research, modular composition is the process for creating a collection of individual musical ideas (e.g., sequences, patterns, phrases) termed ‘modules’, and designing a dynamic system for their assembly into cohesive structures. This approach results in musical works that exist in a state of constant structural flux, allowing for real-time alteration while progressing beyond similar existing approaches observed in video game music and interactive music apps, from which this research takes inspiration. Approaches involving compositionally focused intelligent music systems are also observed, highlighting how modular composition bridges traditional compositional practices and the design of interactive music systems. Two of the authors’ own works are discussed with regard to how modular composition can be implemented in varying creative ways. The outcome of this work illuminates the creative possibilities of integrating traditional compositional practices with new digital approaches to arrive at a more structurally plastic and alterable form of music.
Innovative pricing and payment schemes have been proposed to address the affordability issues raised by new health technologies or the uncertainty about their long-term safety and effectiveness. As part of the Horizon Europe project HI-PRIX, we investigated the nature, scope, and impact of these arrangements.
Methods
We undertook a PRISMA-ScR-compliant review in PubMed, Web of Science, and Scopus, from 2010 to 2023. We also searched health technology assessment (HTA) agency websites. The search strategy was structured around two blocks: “pricing/payment schemes,” and “innovativeness.” Studies illustrating pricing/payment schemes with sufficient level of details to explain their functioning were selected, also through a nested evaluation of an artificial-intelligence-powered tool for systematic reviews. These schemes were classified according to several criteria, such as their purpose, nature, governance, product category, data collection needs, foreseen distribution of risk, and implementation challenges. The study protocol was published in PROSPERO (CRD42023444824).
Results
“Innovative payment and pricing schemes” were defined as arrangements that go beyond price per unit of the technology, simple price/volume agreements, or expenditure caps. Seventy innovative schemes were identified, of which 25 were only illustrated theoretically, while 45 have been implemented in practice. So far, 170 real cases of implementation have been identified. The schemes target pharmaceuticals, vaccines, and/or medical devices. Whether designed to incorporate unique features of a given technology, or to address specific challenges, the schemes can be classified by different value drivers, including type of technology, therapeutic indication, or timeline of the agreement.
Conclusions
Available pricing and payment schemes have the potential to offer a comprehensive toolkit to policymakers facing reimbursement and access decisions, highlighting that it is not the scheme per se that is innovative, rather its application/use in a given context or for a given challenge. The catalog populates the Pay for Innovation Observatory, a publicly available repository.
A reflective analysis is presented on the potential added value that actuarial science can contribute to the field of health technology assessment. This topic is discussed based on the experience of several experts in health actuarial science and health economics. Different points are addressed, such as the role of actuarial science in health, actuarial judgment, data inputs and their quality, modeling methodologies and the use of decision-analytic models in the age of artificial intelligence, and the development of innovative pricing and payment models.
Usage data on research outputs such as books and journals is well established in the scholarly community. Yet, as research impact is derived from a broader set of scholarly outputs, such as data, code, and multimedia, more holistic usage and impact metrics could inform national innovation and research policy. While usage data reporting standards, such as Project COUNTER, provide the basis for shared statistics reporting practice, mandated access to publicly funded research has increased the demand for impact metrics and analytics. In this context, stakeholders are exploring how to scaffold and strengthen shared infrastructure to better support the trusted, multistakeholder exchange of usage data across a variety of outputs. In April 2023, a workshop on Exploring National Infrastructure for Public Access and Impact Reporting supported by the United States (US) National Science Foundation (NSF) explored these issues. This paper contextualizes the resources shared and recommendations generated in the workshop.
This chapter describes some of what we know so far about a possible Multicultural British English (MBE) by first explaining where it fits in terms of Multicultural London English (MLE) and how it has been labelled up to now. It draws upon research which has investigated varieties of English that appear to contain features of MLE, yet which are used outside of London. In doing so, it explores how local and supralocal linguistic features might work alongside features of MLE to create regional versions of an underlying variety of English, MBE, that exists in various locations across the UK. The chapter describes a few of the phonological, lexical and syntactic features of a Manchester-oriented MBE, before providing insights into the extent to which some of its speakers are aware of the language they use. Finally, the chapter discusses the role of grime music in the development and possible diffusion of MBE, and calls for further research to be carried out.
Although clozapine is the most effective antipsychotic for people with treatment-resistant schizophrenia (TRS), only 40% of people with TRS respond, and there is limited evidence for augmentation agents. Cannabidiol (CBD) reduces positive symptoms in individuals with schizophrenia, but no trials have specifically examined its efficacy in those with clozapine-resistant schizophrenia.
Aims
To examine the clinical efficacy of CBD augmentation in people with clozapine-resistant schizophrenia.
Method
This is a 12-week randomised, placebo-controlled, double-blind, parallel-group trial (registration number: ACTRN12622001112752). We will recruit 88 individuals with clozapine-resistant schizophrenia, randomised (1:1) to 1000 mg daily CBD versus placebo. Eligible individuals will be aged between 18 and 64 years, fulfil DSM-IV criteria for schizophrenia or schizoaffective disorder, have a total PANSS (Positive and Negative Syndrome Scale) score ≥60, have received oral clozapine for at least 18 weeks and have a clozapine level of >350 ng/mL. Interim analyses will be conducted at 25, 50 and 75% recruitment; these will also provide an opportunity to reallocate participants dependent on conditional power. The primary endpoint will be the difference in PANSS positive scores at the end of week 12. Secondary endpoints include depression, anxiety, sleep, quality of life, alcohol consumption, change in weight and metabolic syndrome components, and neurocognitive measures, as well as safety and tolerability.
Discussion
Novel treatments for clozapine-resistant schizophrenia are urgently needed. If found to be effective, CBD may have a role as a novel and safe adjunct to clozapine.
On February 2, 2024, the International Court of Justice (the Court) delivered its preliminary objections judgment in the case brought by Ukraine against Russia under the Convention on the Prevention and Punishment of the Crime of Genocide (the Genocide Convention).
Edited by
David Kingdon, University of Southampton,Paul Rowlands, Derbyshire Healthcare NHS foundation Trust,George Stein, Emeritus of the Princess Royal University Hospital
Obsessive-compulsive disorder (OCD) is a chronic and debilitating illness. It has a specific natural history and treatment response that merits separate attention. This chapter provides a comprehensive update on the origins, aetiology and treatment of OCD. We also touch upon advances in the understanding of a group of less-well-researched disorders related to and currently classified together with OCD, termed as the obsessive-compulsive and related disorders (OCRDs). However, the main focus of this chapter will be on OCD.
Edited by
David Kingdon, University of Southampton,Paul Rowlands, Derbyshire Healthcare NHS foundation Trust,George Stein, Emeritus of the Princess Royal University Hospital
Specific phobia is a condition characterised by an intense reaction of fear and avoidance to a situation or an object perceived as dangerous. Individuals might rationally understand the situation is not in reality dangerous, but often, even the thought of the specific situation or object evokes intense anxiety. Various studies report the lifetime prevalence of specific phobia, which ranges from 3 to 15 per cent, with incidence predominantly occurring during adolescence. This disorder often leads to a reduction in the quality of life and can cause significant functional impairment. Various theories from genetic to psychological, including those drawing inferences from psychodynamic and cognitive behavioural therapies, offer explanations about the aetiology of specific phobias. Exposure therapy and SSRIs are recognised treatment options for individuals with specific phobias.
This study uses a modified online version of the “draw-a-map” task and Garrett, Williams, and Evans’ (2005b) “keywords” methodology to explore the geospatial distribution of different accent and dialect labels and descriptors in Greater Manchester, UK. Specifically, we consider the distribution of the three most frequent labels related to “accentedness”: Broad, Strong, and Soft, as provided by 349 Greater Manchester residents. This analysis finds that these descriptors were clustered in separate areas of Greater Manchester, suggesting that they were being used to describe perceptually distinct varieties of English. In order to uncover the nuances in these folk-linguistic terms, we consider how they correlate with other concepts emerging from the dataset, finding that they are being used to differentiate between varieties with contrasting social associations. By combining innovative approaches, this study demonstrates how the subtleties of folk-linguistic modes of awareness can be uncovered through in-depth analysis of the terminology employed to describe linguistic variation on a very local scale. In so doing, it paves the way for further development of draw-a-map techniques that will enable similarly nuanced analysis in different regions, thus pushing the sub-discipline forward.
Regulatory impact assessment (RIA) is an appraisal tool to bring evidence to bear on regulatory decisions. A key property of RIA is that is corrects errors in reasoning by pushing regulators towards deliberative thinking to override intuitive judgments. However, the steps for regulatory analysis suggested by international organisations and governmental handbooks do not handle two sources of bias and barriers that are well documented in the literature on behavioural insights. First, bias enters the process via knowledge production during the analytical process of assessment. Second, bias affects knowledge utilisation when regulators “read” or utilise the results of RIA. We explore these two pathways by focusing on drivers of behaviour rather than lists of biases. The conclusions reflect on the limitations of current practice and its possible improvement, making suggestions for an RIA architecture that is fully informed by behavioural analysis.
Mineral species are known to be heterogeneously distributed throughout the Earth such that a relatively small number of minerals make up a large proportion of the lithosphere while the majority of all known minerals are rare and have been identified at only a small number of locations that frequently exhibit high levels of species richness. Intuitive understandings of mineral scarcity and abundance are reconsidered through the characterisation of the quantitative aspects of spatio-temporal trends in new mineral discovery. Using data drawn from online mineralogical databases, it is found that the Earth's mineral hotspots exhibit an exponential distribution of species abundance, while those same mineral hotspots exhibit a power-law distribution in the number of minerals first recognised at those locations. That is, locations rich in first occurrences are extremely rare, even when considering only the Earth's most species-rich mineral locations. Global distributions of mineral scarcity and abundance can be estimated from the number of mineral-location pairs for each species reported in a database. Two-thirds of all known species have been reported from ten or fewer locations and the frequency distribution of these mineral-location pairs exhibit a power-law distribution that extends with increasing dispersion over several orders of magnitude of mineral abundance. Initially, nearly all minerals are first reported from only their type locality. Over time, additional occurrences of newly discovered minerals are reported at an average rate of one new location per mineral every 5.5 years. As a result, the percentage of minerals that were discovered in a given year that continue to be known only from their type locality is found to decline exponentially over time. However, a few minerals remain known from only their type locality for long periods, including some that were first identified in the 19th Century. Conversely, other recently identified minerals have been subsequently recognised at locations spanning a wide geographic range such that the number of minerals with cosmopolitan distributions is found to increase exponentially over time. Taken together, these several quantitative representations of mineral distributions lend structure and refinement to qualitative and intuitive notions of the scarcity and abundance of Earth's many minerals.
The clay particles in a kaolin deposit from Brazil were investigated by X-ray diffraction (XRD), differential thermal analysis (DTA), analytical transmission electron microscopy (ATEM), and electron paramagnetic resonance (EPR) to examine the relationships between morphological and chemical properties of the crystals and to relate these properties to formation conditions. The XRD patterns show the dominant presence of kaolinite with minor amounts of gibbsite, illite, quartz, goethite, hematite, and anatase. ATEM observations show two discontinuities in the deposit as indicated by changes in morphology and size of the kaolinite crystals. At the base of the deposit, hexagonal platy and lath-shaped particles (mean area of 001 face = 0.26 μm2) maintain the original fabric of the parent rock which characterizes an in situ evolution. In the middle of the deposit a bimodal population of large (mean area of 001 face > 0.05 μm2) and small (mean area of 001 face < 0.05 μm2) sub-hexagonal platy kaolinite crystals occurs. This zone defines the boundary between the saprolitic kaolinite and the pedogenic kaolinite. Near the top of the profile, laths and irregular plates of kaolinite, together with sub-hexagonal particles, define two different depositional sources in the history of formation of the deposit. Crystal thickness as derived from the width of basal reflections and the Hinckley index are compatible with the morphological results, but show only one discontinuity. At the base of the deposit, kaolinite has a low- defect density whereas in the middle and at the top of the profile, kaolinite has a high-defect density. Likewise, EPR spectroscopy shows typical spectra of low-defect kaolinite for the bottom of the deposit and typical spectra of high-defect kaolinite for the other portions of the deposit. Despite the morphological changes observed through the profile, the elemental composition of individual kaolinite crystals did not show systematic variations. These results are consistent with the deposit consisting of a transported pedogenic kaolinite over saprolite consisting of in situ kaolinized phyllite.
This chapter covers major late period works, which are in many ways increasingly more twenty-first century rather than eighteenth or nineteenth century: full of contradictions and energy.