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Sixty years have passed since occupiers in England and Wales were placed under a statutory duty to keep visitors to occupied premises reasonably safe. The legislation, however, did not detail the exact operation of this duty of care. The case law, expected to fill in the gaps, has arguably developed without sufficient consistency and/or predictability. This apparent confusion can be remedied through applying a systematic test to the question of whether a breach of duty has occurred. The test follows the verification that the case falls within the field of occupiers’ liability because of the presence of a danger attributable to the state of the premises. It consists of three consecutive stages which ask: (1) whether the risk of injury was foreseeable; (2) whether the occupier could reasonably have been expected to have addressed this very particular risk; and (3) whether any remedial action the occupier actually took was appropriate.
Item 9 of the Patient Health Questionnaire-9 (PHQ-9) queries about thoughts of death and self-harm, but not suicidality. Although it is sometimes used to assess suicide risk, most positive responses are not associated with suicidality. The PHQ-8, which omits Item 9, is thus increasingly used in research. We assessed equivalency of total score correlations and the diagnostic accuracy to detect major depression of the PHQ-8 and PHQ-9.
We conducted an individual patient data meta-analysis. We fit bivariate random-effects models to assess diagnostic accuracy.
16 742 participants (2097 major depression cases) from 54 studies were included. The correlation between PHQ-8 and PHQ-9 scores was 0.996 (95% confidence interval 0.996 to 0.996). The standard cutoff score of 10 for the PHQ-9 maximized sensitivity + specificity for the PHQ-8 among studies that used a semi-structured diagnostic interview reference standard (N = 27). At cutoff 10, the PHQ-8 was less sensitive by 0.02 (−0.06 to 0.00) and more specific by 0.01 (0.00 to 0.01) among those studies (N = 27), with similar results for studies that used other types of interviews (N = 27). For all 54 primary studies combined, across all cutoffs, the PHQ-8 was less sensitive than the PHQ-9 by 0.00 to 0.05 (0.03 at cutoff 10), and specificity was within 0.01 for all cutoffs (0.00 to 0.01).
PHQ-8 and PHQ-9 total scores were similar. Sensitivity may be minimally reduced with the PHQ-8, but specificity is similar.
This study evaluated in a rigorous 18-month randomized controlled trial the efficacy of an enhanced vocational intervention for helping individuals with a recent first schizophrenia episode to return to and remain in competitive work or regular schooling.
Individual Placement and Support (IPS) was adapted to meet the goals of individuals whose goals might involve either employment or schooling. IPS was combined with a Workplace Fundamentals Module (WFM) for an enhanced, outpatient, vocational intervention. Random assignment to the enhanced integrated rehabilitation program (N = 46) was contrasted with equally intensive clinical treatment at UCLA, including social skills training groups, and conventional vocational rehabilitation by state agencies (N = 23). All patients were provided case management and psychiatric services by the same clinical team and received oral atypical antipsychotic medication.
The IPS–WFM combination led to 83% of patients participating in competitive employment or school in the first 6 months of intensive treatment, compared with 41% in the comparison group (p < 0.005). During the subsequent year, IPS–WFM continued to yield higher rates of schooling/employment (92% v. 60%, p < 0.03). Cumulative number of weeks of schooling and/or employment was also substantially greater with the IPS–WFM intervention (45 v. 26 weeks, p < 0.004).
The results clearly support the efficacy of an enhanced intervention focused on recovery of participation in normative work and school settings in the initial phase of schizophrenia, suggesting potential for prevention of disability.
Different diagnostic interviews are used as reference standards for major depression classification in research. Semi-structured interviews involve clinical judgement, whereas fully structured interviews are completely scripted. The Mini International Neuropsychiatric Interview (MINI), a brief fully structured interview, is also sometimes used. It is not known whether interview method is associated with probability of major depression classification.
To evaluate the association between interview method and odds of major depression classification, controlling for depressive symptom scores and participant characteristics.
Data collected for an individual participant data meta-analysis of Patient Health Questionnaire-9 (PHQ-9) diagnostic accuracy were analysed and binomial generalised linear mixed models were fit.
A total of 17 158 participants (2287 with major depression) from 57 primary studies were analysed. Among fully structured interviews, odds of major depression were higher for the MINI compared with the Composite International Diagnostic Interview (CIDI) (odds ratio (OR) = 2.10; 95% CI = 1.15–3.87). Compared with semi-structured interviews, fully structured interviews (MINI excluded) were non-significantly more likely to classify participants with low-level depressive symptoms (PHQ-9 scores ≤6) as having major depression (OR = 3.13; 95% CI = 0.98–10.00), similarly likely for moderate-level symptoms (PHQ-9 scores 7–15) (OR = 0.96; 95% CI = 0.56–1.66) and significantly less likely for high-level symptoms (PHQ-9 scores ≥16) (OR = 0.50; 95% CI = 0.26–0.97).
The MINI may identify more people as depressed than the CIDI, and semi-structured and fully structured interviews may not be interchangeable methods, but these results should be replicated.
Declaration of interest
Drs Jetté and Patten declare that they received a grant, outside the submitted work, from the Hotchkiss Brain Institute, which was jointly funded by the Institute and Pfizer. Pfizer was the original sponsor of the development of the PHQ-9, which is now in the public domain. Dr Chan is a steering committee member or consultant of Astra Zeneca, Bayer, Lilly, MSD and Pfizer. She has received sponsorships and honorarium for giving lectures and providing consultancy and her affiliated institution has received research grants from these companies. Dr Hegerl declares that within the past 3 years, he was an advisory board member for Lundbeck, Servier and Otsuka Pharma; a consultant for Bayer Pharma; and a speaker for Medice Arzneimittel, Novartis, and Roche Pharma, all outside the submitted work. Dr Inagaki declares that he has received grants from Novartis Pharma, lecture fees from Pfizer, Mochida, Shionogi, Sumitomo Dainippon Pharma, Daiichi-Sankyo, Meiji Seika and Takeda, and royalties from Nippon Hyoron Sha, Nanzando, Seiwa Shoten, Igaku-shoin and Technomics, all outside of the submitted work. Dr Yamada reports personal fees from Meiji Seika Pharma Co., Ltd., MSD K.K., Asahi Kasei Pharma Corporation, Seishin Shobo, Seiwa Shoten Co., Ltd., Igaku-shoin Ltd., Chugai Igakusha and Sentan Igakusha, all outside the submitted work. All other authors declare no competing interests. No funder had any role in the design and conduct of the study; collection, management, analysis and interpretation of the data; preparation, review or approval of the manuscript; and decision to submit the manuscript for publication.
On a hot day in the 1960s Philip Rieff was out walking in his trademark threepiece suit, watch chain and bowler hat. An open- topped sports car pulled up with a young woman in the passenger seat. The driver, in T- shirt and shorts, was Erving Goffman, Rieff's departmental colleague at Pennsylvania. When he suggested to Rieff that he must be stifling in ‘that suit’, the latter looked at the woman and said: ‘Professor Goffman is a rich man who dresses like a poor man. I am poor man who dresses like a rich man’. A commentary of sorts on the presentation of self in everyday life, it was also itself a form of self- presentation, the retort to the colleague's joshing directed not at him but at the third party, and expressed through a conversation- stopping, conversation- preventing bon mot. Goffman himself would more likely analyze than use such a form of talk: though he did pepper his own texts with aphoristic expressions, they never stand alone but rather sum up passages of analysis. They also suggest an opening into further thoughts, as when, following discussion the ways in which people avoid embarrassment in the presence of nudity, he tells us that, ‘when bodies are naked, glances are clothed’. As writers, Rieff and Goffman can seem so different from one another that this alone might account for their differing levels of fame and influence. Where Goffman is dialogic and open, so ‘democratic’ that beginning students often take him to be saying something so obvious that they wonder what the fuss is about, Rieff, who should have found a place on ex- wife Susan Sontag's long list of all things camp, once said that there were only 17 people in the world who understood him. While neither characterization is quite right – Rieff's first two books are a reader's pleasure regardless of content, Goffman's essays are far more technical than they first appear, and he often introduced them as ‘reports’ – Goffman remains required reading for us all, while Rieff is a taste that few today acquire. It was not always so: Rieff was influential beyond sociology in the late 1950s and 1960s, then forgotten about by the 1980s, and picked up again around the time of his death in 2006.
The term “totalitarianism” is an awkward one. First, while the suffix “- ism” suggests an ideology, like liberalism or socialism, few have said “I am a totalitarian” in the way they have said “I am a liberal” or “I am a socialist.” Second, while “totalitarianism” is sometimes treated as the name of an object of inquiry, the adjective “totalitarian” is often used beyond the historical context in which it first arose. Ambiguity surrounds the scope of the term, too: Does it refer to forms of government, to types of state or to whole societies? Do we need it at all? Can we say what needs to be said by making use of other terms such as “tyranny” or “dictatorship”?
Totalitarianism between the Political and the Social
A popular misconception has it that “totalitarianism” is a product of the Cold War. To be sure, for some scholars and politicians it has served as a “counter concept” to “liberalism” or “democracy.” Yet when Hannah Arendt published The Origins of Totalitarianism in 1951, the word “totalitarian” was already more than 25 years old (Gleason 1995). It first appeared in Italy in 1923. Early that year, Mussolini had proposed a change in the Italian electoral law to allow the party with the largest share of the vote, as long as that was more than 25 per cent, to receive two- thirds of the seats in the parliament, and thus be able to change the constitution. On 12 May, the leftist journalist and politician Giovanni Amendola published an article in Il Mundo in which he described this as a recipe for “a totalitarian system” of rule; this he contrasted with two others: “majoritarian” and “minoritarian.” As can often happen in political life, Amendola's term for what he disapproved of was quickly adopted by those it was directed against. Mussolini himself referred to “our radical totalitarian will” and “the totalitarian state,” and in 1925 the Fascist theorist Giovanni Gentile went further and proposed a “total conception of life.” By this he meant that “it is impossible to be fascists in politics and non- fascists in schools, non- fascists in our families, non- fascists in our daily occupations.”
Many small deposits of Eemian age, including the stratotype, are found right across the North European plain. In adjacent areas, this interglacial is known by local names such as Ipswichian (Britain), Luhe or Ribains (France), Riss-Würm interglacial (Alps) and Mikulinian (Poland and Russia). It correlates primarily with MIS 5e of the deep-sea stratigraphy, though boundaries may not be exactly the same. Basins containing Eemian sediments rest directly on morainic deposits of all three Saalian ice advances, which must all, therefore, fall within MIS 6.
Indicator species of both plants and animals suggest that mean July temperatures in the early-temperate part of the interglacial were warmer than during the Holocene. For many years, palynologists have recognised a very uniform succession of temperate tree acme pollen zones and a substantial late-temperate expansion of Carpinus as hallmarks of this interglacial across much of northern Europe. In southern England, however, deposits with a similar pollen signature are being recognised on stratigraphie and palaeontological grounds as characterising not only the Ipswichian but also the previously poorly-defined interglacial stage correlating with MIS 7. High Carpinus values are known from these latter sites and from the Le Bouchet inter-glacial of the French Massif Central, also clearly correlated with MIS 7. Thus stratigraphie confusion and misinterpretations may have occurred at supposedly Eemian/Ipswichian sites unrelated to the glacial stratigraphy or to deep continuous records.
The uniformity and rapid development of Eemian vegetational successions may be ascribed to (1) rapid warming and the lack of any late-glacial climatic oscillation on the scale of the Younger Dryas, (2) the development of an open marine connection in the first half of the interglacial from the English Channel across the North and Baltic Seas to the White Sea and the Arctic Ocean, and (3) the occurrence of Saalian per-glacial refugia for Carpinus, not only in the Balkans but also on the Iberian peninsula, permitting much more rapid northward colonisation of Europe during this interglacial.
The question of climatic events within the Eemian is far from settled. Not only is the ice-core evidence ambiguous and awaiting further clarification, but the scale and synchroneity of proposed events at different continental sites in both northern and southern Europe show no clear pattern at present; clearly there is a need for more detailed investigation and interpretation. Likewise there is ongoing debate about the duration of this interglacial and its detailed correlation with the deep-sea core record and events within the North Atlantic Ocean.
Political science departments often require a senior-capstone course as part of the major. The Wahlke Report (1991) recommended including such a course more than 20 years ago, and the Association of American Colleges and Universities considers it a high-impact practice. Colleges and universities are also advocating broad efforts of civic engagement—an approach to academic work for which political science majors are uniquely qualified. This article describes the successes and failures of partnering a senior-capstone course with seven public agencies in a small city. By developing a multistage process for interacting with agencies, city officials, and the public, this “State of the Community” project provides students with a real-world opportunity to serve as political consultants. By emphasizing the importance of timeliness, teamwork, presentation skills, and professionalism, this project can be a turning point for political science students who must soon transition from students in the undergraduate world to citizens in the community.
Structural brain measures are employed as endophenotypes in the search for schizophrenia susceptibility genes. We analyzed two independent structural imaging datasets with voxel-based morphometry and with source-based morphometry, a multivariate, independent components analysis, to determine the stability and heritability of regional gray matter concentration abnormalities in schizophrenia. The samples comprised 209 and 102 patients with schizophrenia and 208 and 96 healthy volunteers, respectively. The second sample additionally included non-ill siblings of participants with and without schizophrenia. A standard voxel-based analysis showed reproducible regional gray matter deficits in the affected participants compared with unrelated, unaffected controls in both datasets: patients showed significant gray matter concentration deficits in cortical frontal, temporal, and insular lobes. Source-based morphometry (SBM) was applied to the gray matter images of the entire sample to determine the effects of diagnosis on networks of covarying structures. The SBM analysis extracted 24 significant sets of covarying regions (components). Four of these components showed significantly lower gray matter concentrations in patients (p < .05). We determined the familiality of the observed SBM components based on 66 sibling pairs (25 discordant for schizophrenia). Two components, one including the medial frontal, insular, inferior frontal, and temporal lobes, and the other including the posterior occipital lobe, showed significant familiality (p < .05). We conclude that structural brain deficits in schizophrenia are replicable, and that SBM can extract unique familial and likely heritable components. SBM provides a useful data reduction technique that can provide measures that may serve as endophenotypes for schizophrenia.
This article presents a new series of monthly equity returns for the British stock market for the period 1825-1870. In addition to calculating capital appreciation and dividend yields, the article also estimates the effect of survivorship bias on returns. Three notable findings emerge from this study. First, stock market returns in the 1825-1870 period are broadly similar for Britain and the United States, although the British market is less risky. Second, real returns in the 1825-1870 period are higher than in subsequent epochs of British history. Third, unlike the modern era, dividends are the most important component of returns.
The evidence suggests that the Singapore Experiment is not an isolated example. Richard Florida, a geographer, and several other writers have suggested that what might be happening is nothing less than a worldwide phenomenon he calls The Rise of the Creative Class. If such a class is arising not just in America, but in Europe and East Asia, then what is set out in this book may be an effective way of teaching a new class of innovators and creative employees. This research might be even more widely relevant.
Florida began by imagining a time traveller who had switched from 1900 to 1950 and again from 1950 to 2000 and beyond. At first blush the half-century to 1950 contained most of the world-changing surprises, the automobile, the Federal Highway System, the aeroplane and jet engine, the airline industry, radio and television, the telephone and even the first computer. The world of 1900 would be barely recognizable from the heights of Manhattan skyscrapers.
Yet the time traveller from 1950 to 2000 would recognize most, if not all, of our technologies. Admittedly, computers have become personal and telephones mobile and we are now connected to the Internet, but the general principles were not so far apart. Our traveller to 2000 would not be whisked out of his horse and buggy and brownstone into a totally transformed world. He would surely be less bewildered. Perhaps this is so, but our traveller could be bewildered for different reasons. What changed in the first part of the century was the physical infrastructure.