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.
With good reason, the historian Bernard Bailyn – writing near the end of the twentieth century – described the “peopling of British North America” as “the most sweeping and striking development in this millennium of Western history.” The movement of people from one side of the ocean to the other “transformed at first half the globe, ultimately the whole of it, more fundamentally than any development except the Industrial Revolution.” He was not alone in believing this. Bismarck, as he reminded us, had called the migration of so many “the decisive fact in the modern world.” The movement of men and women from the Old World to the New, and this is fairly uncontestable, made British North America and then the United States distinctive, creating a diverse cultural landscape, just as the flow increased the productive capacity of the West in ways that no one could have anticipated. Migration produced untold wealth, expanded the territorial footprints of colonies and then states, remade the political economy and the social fabric of the broader Atlantic, and would make the United States one of the most powerful nations in the world. The story of migration is the story of America.
Catatonia, a severe neuropsychiatric syndrome, has few studies of sufficient scale to clarify its epidemiology or pathophysiology. We aimed to characterise demographic associations, peripheral inflammatory markers and outcome of catatonia.
Electronic healthcare records were searched for validated clinical diagnoses of catatonia. In a case–control study, demographics and inflammatory markers were compared in psychiatric inpatients with and without catatonia. In a cohort study, the two groups were compared in terms of their duration of admission and mortality.
We identified 1456 patients with catatonia (of whom 25.1% had two or more episodes) and 24 956 psychiatric inpatients without catatonia. Incidence was 10.6 episodes of catatonia per 100 000 person-years. Patients with and without catatonia were similar in sex, younger and more likely to be of Black ethnicity. Serum iron was reduced in patients with catatonia [11.6 v. 14.2 μmol/L, odds ratio (OR) 0.65 (95% confidence interval (CI) 0.45–0.95), p = 0.03] and creatine kinase was raised [2545 v. 459 IU/L, OR 1.53 (95% CI 1.29–1.81), p < 0.001], but there was no difference in C-reactive protein or white cell count. N-Methyl-d-aspartate receptor antibodies were significantly associated with catatonia, but there were small numbers of positive results. Duration of hospitalisation was greater in the catatonia group (median: 43 v. 25 days), but there was no difference in mortality after adjustment.
In the largest clinical study of catatonia, we found catatonia occurred in approximately 1 per 10 000 person-years. Evidence for a proinflammatory state was mixed. Catatonia was associated with prolonged inpatient admission but not with increased mortality.
It is now nearly forty years since John Burnett, David Vincent, and David Mayall compiled their invaluable and much-used three-volume finding aid, The Autobiography of the Working Class: An Annotated, Critical Bibliography (1984–1989), and established working-class autobiography as an important documentary source for exploring the lives of the working poor. Life writing now forms the basis of historical research into areas such as the emotions and domestic life that had hardly been imagined at the time that the annotated bibliography was produced. Yet as research into working-class autobiography has extended into new domains of enquiry, there has been less innovation in methodology. Historians typically use autobiographical material to pursue deep-reading strategies and unpack the meaning, experience, and identity of individual writers rather than generalize about working-class life more broadly. In this article I offer an alternative strategy: to take the autobiographical corpus and read it at scale in order to better understand fatherhood in Victorian Britain. Through a combination of intensive and extensive reading, I demonstrate that many working-class men failed to live up to expectations as breadwinners, and I explore the ramifications of that failure for the women and children with whom they lived.
The definition of combined approaches is broad. This can include multiple portals to the same or different region in the skull base. The “pull-through technique is a versatile, dual-keyhole approach developed to attach tumors that extend between the temporal and occipital poles. This approach is complex, as it entails a knowledge of the intricate anatomy and eloquent cortical and subcortical structures in this region. This combined approach is tailed to minimize peripheral brain damage while providing a direct route to the pathology. This chapter discusses the indications, the anatomy, the patient selection, and the surgical nuances of this approach.
People with late-stage Alzheimer’s disease and related dementias (ADRD) who are assumed to have lost coherent cognitive capacity may exhibit unexpected episodes of spontaneous, meaningful, and relevant communication or behavior. Most reports of paradoxical lucidity or “episodes of lucidity” (EL) are anecdotal or case studies. Given the transient nature and lack of scientific explanation of the phenomenon, EL is under-investigated and poorly understood.
To develop an operational definition of and typologies for EL, we conducted a pilot study of former and current family caregivers from UsAgainstAlzheimer’s A-LIST® (N = 480). Over sixty percent of caregivers (n = 294, 61%) reported witnessing at least one EL with their care recipient over the course of dementia. Most episodes happened in late stages of dementia (71%). Only 10% happened within 7 days before death. The majority of episodes (71%) lasted <30 minutes. About half the episodes were characterized by uncharacteristic speech and communication. Caregivers perceived these experiences positively (M = 4.1; range = 1–5), but also expressed desire to know why/when EL occurs and how to respond to it.
We plan to use these data to refine definitions and typologies to incorporate into a prospective, demographically diverse survey to family caregivers to assess predictors of EL and linking EL to caregiver well-being and bereavement response. Precise and robust operationalizations of EL will allow future research to assess if EL has different effects on ADRD prognosis or alters how family members understand, manage and adapt to a PLWD’s dementia progression.
The ideal management of patients with an acute TBI allows accurate and timely diagnosis of complex problems which occur immediately and less acutely post TBI.
Major Trauma Networks were developed in order to get the right patient to the right place at the right time.
Pre-hospital TBI care has greatly improved over the past few decades. This care emphasizes rapid, safe extrication of the trauma victim, stabilization of the spine, aggressive resuscitation to prevent hypotension, immediate airway management and rapid, safe transport to an appropriate trauma centre.
Most TBIs are preventable, and demographics are changing. Whilst TBI from high velocity injuries in young males still occur, the burgeoning elderly population with TBIs from falls from standing are increasing considerably.
Sport related TBIs have received significant media coverage in recent years, in part due to an increased body of scientific literature and growing concern surrounding their long term effects.
With the development and application of advanced mild TBI assessment tools, there is a rising tide of data that is driving changes in clinical practices and the management of patients with mild TBI.
Although research has demonstrated the positive nutritional value and environmental benefits associated with edible insect consumption, several factors challenge the growth and development of the edible insect industry for human consumption in the US and Canada. Cultural and psychological factors account for much of the aversion US and Canadian consumers display. The absence of specific regulation also constitutes a structural barrier to more widespread production and sale of edible insects. Compared to the US, the European Union has a more developed edible insect industry and has enacted legislation that removes some of the barriers. As consumer awareness of the putative health benefits of edible insects increases, more comprehensive regulations may emerge to keep pace with the growth of this industry. Overall, a multi-disciplinary approach that addresses both benefits and barriers to consumption is needed to facilitate a robust market for edible insects in the US and Canada.
About 800 foodborne disease outbreaks are reported in the United States annually. Few are associated with food recalls. We compared 226 outbreaks associated with food recalls with those not associated with recalls during 2006–2016. Recall-associated outbreaks had, on average, more illnesses per outbreak and higher proportions of hospitalisations and deaths than non-recall-associated outbreaks. The top confirmed aetiology for recall-associated outbreaks was Salmonella. Pasteurised and unpasteurised dairy products, beef and molluscs were the most frequently implicated foods. The most common pathogen−food pairs for outbreaks with recalls were Escherichia coli-beef and norovirus-molluscs; the top pairs for non-recall-associated outbreaks were scombrotoxin-fish and ciguatoxin-fish. For outbreaks with recalls, 48% of the recalls occurred after the outbreak, 27% during the outbreak, 3% before the outbreak, and 22% were inconclusive or had unknown recall timing. Fifty per cent of recall-associated outbreaks were multistate, compared with 2% of non-recall-associated outbreaks. The differences between recall-associated outbreaks and non-recall-associated outbreaks help define the types of outbreaks and food vehicles that are likely to have a recall. Improved outbreak vehicle identification and traceability of rarely recalled foods could lead to more recalls of these products, resulting in fewer illnesses and deaths.
Although insomnia disorder and social anxiety disorder are among the most prevalent psychiatric disorders, no studies have yet evaluated the use of sequential evidence-based treatment protocols in the population with co-morbid social anxiety disorder and insomnia disorder.
This study aimed to investigate the effects of sequential treatments on co-morbid insomnia disorder and social anxiety disorder. As depression is a common co-morbid syndrome for both insomnia and social anxiety, a secondary aim was to examine depressive symptoms.
A single-case repeated crossover AB design was used. Ten participants between 18 and 59 years of age with co-morbid DSM-5 diagnoses of insomnia disorder and social anxiety disorder received sequential treatments with cognitive behavioural therapy (CBT). Seven participants completed the treatment course. The primary outcomes were symptoms of insomnia and social anxiety, and the secondary outcome was symptoms of depression.
The effects of CBT on people with co-morbid social anxiety disorder and insomnia disorder were mixed. The majority of participants improved their sleep quality and lessened symptoms of social anxiety and depression. However, participants differed in their degree of improvement concerning all three disorders.
Sequential CBT treatments are potentially effective at decreasing symptoms of social anxiety and insomnia for people with co-morbid social anxiety disorder and insomnia disorder. The variation in outcome across participants makes firm conclusions about the treatment efficacy difficult to draw.
We observed an overall increase in the use of third- and fourth-generation cephalosporins after fluoroquinolone preauthorization was implemented. We examined the change in specific third- and fourth-generation cephalosporin use, and we sought to determine whether there was a consequent change in non-susceptibility of select Gram-negative bacterial isolates to these antibiotics.
Retrospective quasi-experimental study.
Fluoroquinolone preauthorization was implemented in the hospital in October 2005. We used interrupted time series (ITS) Poisson regression models to examine trends in monthly rates of ceftriaxone, ceftazidime, and cefepime use and trends in yearly rates of nonsusceptible isolates (NSIs) of select Gram-negative bacteria before (1998–2004) and after (2006–2016) fluoroquinolone preauthorization was implemented.
Rates of use of ceftriaxone and cefepime increased after fluoroquinolone preauthorization was implemented (ceftriaxone RR, 1.002; 95% CI, 1.002–1.003; P < .0001; cefepime RR, 1.003; 95% CI, 1.001–1.004; P = .0006), but ceftazidime use continued to decline (RR, 0.991, 95% CI, 0.990–0.992; P < .0001). Rates of ceftazidime and cefepime NSIs of Pseudomonas aeruginosa (ceftazidime RR, 0.937; 95% CI, 0.910–0.965, P < .0001; cefepime RR, 0.937; 95% CI, 0.912–0.963; P < .0001) declined after fluoroquinolone preauthorization was implemented. Rates of ceftazidime and cefepime NSIs of Enterobacter cloacae (ceftazidime RR, 1.116; 95% CI, 1.078–1.154; P < .0001; cefepime RR, 1.198; 95% CI, 1.112–1.291; P < .0001) and cefepime NSI of Acinetobacter baumannii (RR, 1.169; 95% CI, 1.081–1.263; P < .0001) were increasing before fluoroquinolone preauthorization was implemented but became stable thereafter: E. cloacae (ceftazidime RR, 0.987; 95% CI, 0.948–1.028; P = .531; cefepime RR, 0.990; 95% CI, 0.962–1.018; P = .461) and A. baumannii (cefepime RR, 0.972; 95% CI, 0.939–1.006; P = .100).
Fluoroquinolone preauthorization may increase use of unrestricted third- and fourth-generation cephalosporins; however, we did not observe increased antimicrobial resistance to these agents, especially among clinically important Gram-negative bacteria known for hospital-acquired infections.
The 2012 Health and Social Care Act transferred Addictions commissioning from the NHS to local authorities, leading to cuts of up to 30-50% of budgets and having the greatest impact on inpatient detox services. In a system with such limited capacity, effectively triaging access to detox services and optimising the efficacy of each detox has become increasingly important. NICE offers limited guidelines to assist with making these decisions, focused on assessing the severity of dependence and risk, but provides little detail on specific predictors of success. Our aim is to evaluate the nature of cases referred for inpatient alcohol or opiate detox and their treatment outcomes. This will help develop our understanding of the factors which influence achieving abstinence, and inform future decision-making regarding suitability for inpatient detox and post-detox planning. Conclusions will form part of a review of the local alcohol care pathway guidelines.
A retrospective case note review of all inpatient detox admissions between April 2019-March 2020 (n = 113 patients) is being undertaken. Our data collection tool extracts quantitative and qualitative data based on criteria from Alcohol use disorders (NICE, 2017), Opiate detoxification (NICE, 2019) and local pathway guidelines.
Preliminary analysis of data from November 2019–March 2020 (43 patients) showed that a clearly documented rationale for inpatient detox was recorded in 95% of cases. 100% of cases had a recorded AUDIT score, whilst SADQ scores were recorded in 50% of cases. 33% of cases were admitted to rehab post detox, and 19% were prescribed anti-craving medication. Abstinence at one year was confirmed in 21% of cases. 28% of clients received a second detox within one year. The rationale for inpatient detoxes in this population is to be reported.
Preliminary data may highlight an opportunity to improve pre detox decision-making and post detox care, with confirmed abstinence in only 21% of clients at one year after detox. The low proportion of completed SADQ scores before accessing detox could offer an opportunity to improve client assessment, and the small proportion of clients prescribed anti-craving medication highlights an area of post detox care which could also be improved. The main limitation of this study is the lack of linked analysis of outcome to specific predictors, which is something that could be explored in future. It would also be valuable to gain survey data on the experience of accessing detox from a service user perspective.
WHILE SARAH KAY's previous books focused on the ways in which political structures or figures of thought were expressed through a range of literary genres and manifestations, the most recent monograph we explore in this volume turns to the materiality of the pages on which medieval literature is written: skin. Kay's work has consistently attended to the idea that there is more than text in any discussion of medieval textuality; the figure she uses to do so in Animal Skins is the suture – a term borrowed from Slavoj Žižek – to indicate the moment at which ‘the distinction of levels between content and medium on which reading normally relies is momentarily suspended, with uncanny effect’ (5). A suture is also the stitching together of skin to repair a wound: the figure of the suture in Kay's work, then, becomes a suture itself – as it refers both to the material reminders of physical fragility upon which medieval literature is inscribed, and to an often fleeting feeling of defamiliarisation, shock, or revulsion experienced by readers of that literature, as they encounter it via the medium of a parchment page displaying its origin as the flayed, scraped, soaked, stretched skin of a slaughtered animal.
The work of Animal Skins is heralded in a series of innovative articles, in which Kay explores in meticulous detail the implication and impact of the medieval manufacture of books – artefacts which transmit and represent human culture as a definitive mark of human superiority – from animal skin. In ‘Original Skin’, Kay relates the flaying of animals for parchment to the hagiography of Saint Bartholomew, who, according to legend, was tortured by being skinned alive: the skin that is removed is often represented in manuscripts as looking like a second body (50–2). This article is revisited in ‘Legible Skins’, as Kay refines her argument to point out the crucial difference between human and non-human skin in the ways in which modern and medieval readers may find their own embodied experience implicated in their encounter with texts inscribed on vellum. As Kay points out, ‘There are reminders everywhere’ in medieval literature ‘that animal skins are bearers of meaning that can be assumed by speakers of human language or by selves that at other times inhabit human bodies’ (Kay 2011: 17).