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Public health emergencies, including the coronavirus (COVID-19) pandemic, highlight disproportionate impacts faced by populations with existing disparities. Concepts and terms used to describe populations disproportionately impacted in emergencies vary over time and across disciplines, but United States (U.S.) federal guidance and law require equal access to our nation’s emergency resources. At all levels of emergency planning, public health and their partners must be accountable to populations with existing inequities, which requires a conceptual shift towards using the data-driven social determinants of health (SDOH). SDOH are conditions in which people are born, live, learn, work, play, worship, and age that affect a wide range of health, functioning, and quality of life outcomes and risks. This article reviews the historic use of concepts and terms to describe populations disproportionately impacted by emergencies. It also recommends a shift in emergency activities towards interventions that target the SDOH to adequately address long-standing systemic health disparities and socioeconomic inequities in the U.S.
Very little is known concerning the efficacy of psychosocial treatments for patients with insomnia disorder co-morbid with generalized anxiety disorder (GAD).
The aim was to examine the efficacy of cognitive behavioral therapy for insomnia (CBT-I) for patients with insomnia disorder co-morbid with GAD.
Given the limited, previous research on therapies for patients with insomnia disorder co-morbid with GAD, an open trial design was used. Twenty-four patients with insomnia disorder and GAD were administered CBT-I across 10 weeks. Across the study period to 6 months follow-up, the participants completed measures indexing insomnia, anxiety, worry, depression, functional impairment, quality of life, treatment perception (credibility, expectancy and satisfaction), adverse events and putative mechanisms.
Moderate to large effect sizes for CBT-I were observed for insomnia symptoms. In terms of insomnia severity, approximately 61% of the patients responded to CBT-I and 26–48% remitted. Moderate to large effect sizes were also demonstrated for GAD symptoms, depression, functional impairment and quality of life. Roughly one-third of the participants reported an adverse event during CBT-I. Five of the seven putative mechanisms were significantly reversed in the expected direction, i.e. all four cognitive process measures and time in bed.
This open trial indicates that CBT-I is an efficacious intervention for patients with insomnia disorder co-morbid with GAD. The results highlight the need for further research using a randomized controlled trial design with analyses of mechanisms of change.
Food intolerances are commonly reported and are predicted to have gastrointestinal health implications. We aimed to quantify the prevalence of food intolerances among US adults and identify culprit foods through a brief web-based survey.
We invited participation in an online cross-sectional survey involving a single questionnaire. Data were summarised using percentages or medians and interquartile range. Participant characteristics by self-reported food intolerance were compared using the Wilcoxon rank sum test and Pearson’s χ2 test. Adjusted analyses were performed using multivariable logistic regression.
The survey was internet-based via Amazon’s mechanical Turk, a crowdsourcing website for the completion of requester directed tasks.
Adults who were US-based internet users were invited at ages 18–80.
We collected 2133 survey responses (ages 18–79 years). The rate of food intolerance was 24·8 % (95 % CI 23·0, 26·6) in US adults. Younger (P < 0·01), female (P = 0·05) and Asian, African American or multiple race individuals (P < 0·01) predominated. Lactose intolerance was most common. Frequency of a non-lactose food intolerance was 18·1 % (95 % CI 16·5, 19·8). When categorised broadly, grains, fruit, lactose, fish, vegetables, alcohol and nuts were most troublesome for individuals in that order.
Self-reported food intolerance is common in US internet users. The effect of food on gastrointestinal symptoms and avoidant behaviours deserves further attention.
In recent decades, the Swedish economy has been characterized by rather fast economic growth. At the same time, income inequality has increased substantially. In the present study, I investigated who has gained and who has been left behind during this period—how disposable personal income has changed for men and women, as well as for those in different positions in the income distribution. Register data for the total population (aged 20 to 80 years old) from 1983 to 2010 were used and three different positions in the income distribution were investigated: percentile 10, the median, and percentile 99. Five years were selected: 1983, 1991, 2000, 2006, and 2010. Each selected year represents a snapshot and describes the general trend. Results show that women in the 10th percentile have increased their income quite well, a result of increased female labor force participation during the period. This has led to a decrease of the income gap between genders within this group. But results also show a masculinization of low income and poverty, as the male incomes in this group have not increased to the same extent as for males in the other income groups. At the median, both men and women experienced a steady increase of incomes, but the gender gap for ages younger than 50 widened between 2000 and 2010. At the very top, percentile 99, the increase in disposable personal income was enormous; however, the gender gap in income did not decrease.
The purpose of the study was to identify and describe conditions of life and needs of support and public service for clients with a mental disability in a Swedish county population.
Public health care and social service providers identified clients and completed a questionnaire concerning the clients’ conditions of life and their special needs. A consecutively recruited sample of clients completed a similar questionnaire.
Totally, 1261 clients were identified. The prevalence of clients with mental disabilities was in the urban and rural areas, 6.4/1000 inhabitants and 4.5/1000 inhabitants, respectively. The most prevalent unmet need (42.9%) was to participate in social and scheduled activities. Almost half of the group was reported to need support in activities of daily living. Clients living in urban settings more often needed support with activities of daily living (P < 0.001), whereas clients living in rural settings more often needed support with job training (P < 0.001) or finding work (P < 0.01). Clients and psychiatric care providers reported the needs of the clients in the same areas; however, clients reported a fewer number of needs than did the care providers.
By using both psychiatric care and social service providers, effective case findings of clients with a mental disability were possible to achieve. In general, there was high agreement between psychiatric care providers and clients regarding the clients’ number of needs of support and their unmet needs of service. However, at the individual level, the agreement between client and psychiatric care providers was lower.
The purpose of the study is to explore feelings of loneliness among residents in assisted living facilities in terms of how loneliness is experienced and articulated, and what specific factors are related to the experiences. The study used a mixed-method approach. We individually interviewed 13 residents twice over six months. We conducted two focus group interviews and noted our observations each time we met the respondents. Data analysis leaned on abductive reasoning. The respondents described loneliness in versatile, rich ways. It proved to be time and place dependent. It was dependent on the time of day, days of the week and seasons. Lonely time was meaningless and filled with a feeling of waiting. Loneliness was also intertwined with place. None of the respondents called their apartment home; instead they called it a hospital, even a prison. They had to spend long periods of time in their apartments against their will, and their desire to interact with other residents was not met. The respondents felt invisible. Residents’ experiences of loneliness in assisted living facilities are unique and distinctive. Time- and place-dependent experiences of loneliness act as important signals for reflection on how care practices in these facilities could be more satisfying. Loneliness should therefore be a key topic and the target of prevention and interventions.
The microstructure and distribution of the elements have been studied in thin films of a near-equimolar CrNbTaTiW high entropy alloy (HEA) and films with 8 at.% carbon added to the alloy. The films were deposited by magnetron sputtering at 300°C. X-ray diffraction shows that the near-equimolar metallic film crystallizes in a single-phase body centered cubic (bcc) structure with a strong (110) texture. However, more detailed analyses with transmission electron microscopy (TEM) and atom probe tomography (APT) show a strong segregation of Ti to the grain boundaries forming a very thin Ti–Cr rich interfacial layer. The effect can be explained by the large negative formation enthalpy of Ti–Cr compounds and shows that CrNbTaTiW is not a true HEA at lower temperatures. The addition of 8 at.% carbon leads to the formation of an amorphous structure, which can be explained by the limited solubility of carbon in bcc alloys. TEM energy-dispersive X-ray spectroscopy indicated that all metallic elements are randomly distributed in the film. The APT investigation, however, revealed that carbide-like clusters are present in the amorphous film.
For some, commenting and tagging may seem an appealing approach to open archival collections for public participation and engagement. Others see them merely as affordable tools to impress funders and taxpayers, legitimising the institutional existence of archives, without seeing much value in content or interest in the consequences of inviting users to participate. Similarly, there are many factors that motivate people to tag and comment online. Although individuals can tag items for their own sake, without spending thought on whether the tags are of use for others or merely for their personal use (for example books in LibraryThing or images on Flickr). It is an activity that cannot be separated from social exchange and community building.
However, irrespective of the approach to tags and comments – social annotation versus private notetaking – it is apparent that there are different reasons for inviting an audience to annotate. There is also a plethora of views on the usefulness and implications of social annotation, and on what is attainable by inviting users to tag or comment. Further, there are many reasons why people tag and comment, and they perceive the usefulness of their actions in different ways. Tagging and commenting has different effects on individuals and archives. This chapter investigates how to conceptualise tags and comments and the phenomenon of commenting and tagging in the context of archives. It highlights an assortment of theoretical perspectives with potential relevance in trying to understand what social annotation means for participatory archives.
Before turning our attention to understanding how tags and comments are functioning, we commence by exploring their variants and how they can be understood in different ways.
What are tags and comments?
Tags and comments have many similarities, especially from the perspective of archival description. However, as Gursoy et al. note, ‘User-generated tags are not quite like subject categories and not quite like archival descriptive metadata.’ Comparisons of formal metadata and tags have shown considerable differences. Tags are terms, but in comparison with subject terms, they are heterogeneous, stem from different forms of knowledge, and end up with a structure that is more rhizomatic than Aristotelian.5 Comments do not have similarly apparent counterparts in traditional archival des - cription.
Ineffective, aversive and harmful medical treatments are common cross-culturally, historically and today. Using evolutionary game theory, we develop the following model to explain their persistence. Humans are often incapacitated by illness and injury, and are unusually dependent on care from others during convalescence. However, such caregiving is vulnerable to exploitation via illness deception, whereby people feign or exaggerate illness in order to gain access to care. Our model demonstrates that aversive treatments can counter-intuitively increase the range of conditions where caregiving is evolutionarily viable, because only individuals who stand to gain substantially from care will accept the treatment. Thus, contemporary and historical “ineffective” treatments may be solutions to the problem of allocating care to people whose true need is difficult to discern.
This article shows that neither stock markets nor commercial banks had a significant impact on the UK's economic growth from 1850 to 1913. These results are based on a new dataset on paid-in capital of securities listed on the UK's stock exchanges, which is analysed using a vector autoregression with time-varying parameters. Econometric results also indicate that the growth of the banking sector and the capital markets was, to a significant extent, driven by factors other than domestic economic growth.
Background: Recent treatment studies with cognitive behavioural therapy for insomnia (CBT-I) have demonstrated effects on both sleep problems and depression. Two previous studies have indicated that the beneficial effect from CBT-I on depression may come through improved sleep, although insomnia severity during treatment had not previously been investigated as a mediator. Aims: Our aim was to investigate if insomnia severity during treatment mediated between CBT-I and depression severity after treatment, in a sample with co-morbid insomnia and depressive symptomology. We also examined whether depressive severity during treatment mediated between CBT-I and insomnia after treatment. Method: The participants were recruited from advertisements and fulfilled criteria for insomnia diagnosis, and had depressive symptomatology (Beck Depression Inventory-second edition: BDI-II > 13). Two-thirds of the participants were diagnosed with major depressive disorder. The participants received four biweekly group sessions of CBT-I or relaxation training (active control). Insomnia severity (Insomnia Severity Index) and depressive severity (BDI-II) were measured at baseline, mid-treatment, post-treatment and 6-month follow-up. The mid-treatment measures were used as mediators. Results: Mediational analyses demonstrated a significant reciprocal relationship between insomnia severity and depressive severity throughout CBT-I, although mid-treatment insomnia had a stronger effect on depression than mid-treatment depression had on insomnia. The results were similar for both post-treatment and follow-up. Discussion: Some improvement in depressive severity after CBT-I is explained by improved sleep. The findings emphasize the importance of making comorbid insomnia a treatment focus in its own right.
This paper presents a new approach for studying temporal sequences across ordinal variables. It involves three complementary approaches (frequency tables, transitional graphs, and dependency tables), as well as an established adaptation based on Bayesian dynamical systems, inferring a general system of change. The frequency tables count pairs of values in two variables and transitional graphs depict changes, showing which variable tends to attain high values first. The dependency tables investigate which values of one variable are prerequisites for values in another, as a more direct test of causal hypotheses. We illustrate the proposed approaches by analyzing the V-Dem dataset, and show that changes in electoral democracy are preceded by changes in freedom of expression and access to alternative information.
Empirical studies of rationality (syllogisms) in patients with schizophrenia have obtained different results. One study found that patients reason more logically if the syllogism is presented through an unusual content.
To explore syllogism-based rationality in schizophrenia.
Thirty-eight first-admitted patients with schizophrenia and 38 healthy controls solved 29 syllogisms that varied in presentation content (ordinary v. unusual) and validity (valid v. invalid). Statistical tests were made of unadjusted and adjusted group differences in models adjusting for intelligence and neuropsychological test performance.
Controls outperformed patients on all syllogism types, but the difference between the two groups was only significant for valid syllogisms presented with unusual content. However, when adjusting for intelligence and neuropsychological test performance, all group differences became non-significant.
When taking intelligence and neuropsychological performance into account, patients with schizophrenia and controls perform similarly on syllogism tests of rationality.
Based on the verb-oriented method and a unique collection of observations from court records, this article shows that both men and women did almost all categories of work in early modern Sweden. On the level of concrete tasks, however, there was both difference and similarity between the genders. Marital status exerted a strong influence on women's sustenance activities, creating a clear distinction between unmarried and ever-married women. These patterns were probably the effect of a labour legislation that forced young people without independent means to offer their bodies and time to masters and mistresses.