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 email@example.com
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.
Northwest Arkansas, particularly Benton and Washington counties, is one of the highest COVID-19 hot spots in the United States (US), with more than half of all reported cases in this area identifying as Latinx or Pacific Islander, even though these communities account for less than 20% of the overall population. The University of Arkansas for Medical Sciences (UAMS) leveraged their existing relationship with 18 key community partners. Partners collaboratively developed a COVID-19 Response Strategy to ensure coordinated effort for Latinx and Pacific Islander communities with four interrelated strategies: health education, testing, contact tracing, and supported quarantine/case management.
This post-authorization safety survey evaluated the long-term safety, tolerability, and efficacy of risperidone long-acting injectable (RLAI) in routine clinical practice.
In this 6-month, multicenter, European, naturalistic survey, patients were included if, during routine clinical practice, long-term antipsychotic therapy with RLAI was deemed necessary by the treating physician. Efficacy measures (at baseline and after 1, 3, 6 months) included Clinical Global Impression-Severity (CGI-S) and Global Assessment of Functioning (GAF). Safety was evaluated by recording treatment-emergent adverse events (TEAEs) at every visit.
RLAI was initiated in 5,134 predominantly male (58.6%) patients (aged 14-94 years) with a diagnosis of paranoid schizophrenia (69.8%). RLAI initial doses were 25 mg every-two-weeks in 37.0%, or 50 mg in 44.4% of patients. at endpoint, RLAI dosages were 50 mg in 49.3% of patients, 25 mg in 27.0%, and 37.5 mg in 22.1%. Six-month treatment with RLAI was completed by 4,314 patients (84.0%). RLAI was discontinued due to loss to follow-up (n=346;6.7%), insufficient response (n=116;2.3%), and AEs (n=106;2.1%). CGI-S significantly improved from baseline to endpoint (p< 0.001). Patient functioning in the GAF scale also significantly improved from baseline to endpoint (45.4±16.0 versus 62.4±17.7, respectively, p< 0.001). TEAEs were recorded by 20% of patients. AEs occurring in ≥5% of patients were akathisia, extrapyramidal disorders, depression, psychotic disorder, anxiety, and weight gain. Serious AEs were reported by 384 (8%) patients.
This large prospective survey confirms the good safety, tolerability, and efficacy of RLAI as reported in previous controlled clinical trials when used in routine clinical practice.
—Horace, Ars Poetica, H & S, VIII, 330, lines 389–90
But neither, Men, nor Gods, nor Pillars meant, Poets should ever be indifferent.
—Ben Jonson, trans., Horace, of the Art of Poetry, 1640, H & S, VIII, 331, lines 555–56
IN my early years of graduate study, I was told by a professor who liked my work that a paper I had written was interesting, even original, but that it was a “broken-backed essay.” Puzzled by the phrase I asked him to explain, and he informed me that I had really attempted to compose two essays and the result was a “broken” piece of literary criticism, something going simultaneously in two directions. Moreover, he pointed out that at times one of these directions seemed to oppose the vector of the other. That made for contradiction, confusion, difficulty in reading. Ultimately, he seemed to say, “what we’ve got here is a failure to communicate!”—it is perhaps no coincidence that this encounter occurred around the same time as the release of Stuart Rosenberg's film, Cool Hand Luke! (1967). But the professor hastened to encourage me because of my “potential” to think and write more coherently and even with some originality. That paper was on Hamlet, and it later became a centerpiece of an MA thesis I wrote on the topic “Self-Consciousness in Shakespearean Drama.” I doubt that the later version had overcome the disability of the earlier one; probably because by then I had begun to suspect that the professional diagnosis that someone has a writing “problem,” because they have difficulty accepting accepted rhetorical protocols, was itself the problem. But when I was told of my “problem” in my first year of graduate school, I probably did work to remedy it with the effect that my writing no doubt became more clear and distinct, but also more cramped and conventional, qualities that then required learning to unlearn, “Broken-backed” is a phrase that has stayed with me my entire academic and professional life, and I think I’ve only recently begun to effectively grasp the significance of a metaphor that conventionally signifies a communication “problem” or even “failure,” for what I consider to be a needed shift in our thinking about thinking, and in our thinking about writing.
Food insecurity is not randomly dispersed throughout the population; rather, there are a number of risk and protective factors shaping both the prevalence and severity of food insecurity across households and sociodemographic populations. The present study examines some of these factors and the role that race and ethnicity among adolescent individuals in north-west Arkansas might play, paying specific attention to a subgroup of Pacific Islanders: the Marshallese.
The study uses cross-sectional survey data collected from a self-administered questionnaire of 10th–12th grade students.
A city in north-west Arkansas, USA.
The number of enrolled students in the selected high school at the time of the survey was 2148. Ten classrooms (116 students) were unable to participate at the time of the survey, making 2032 students eligible to be surveyed. Approximately 22% refused to participate and 105 students were absent from school, yielding a response rate of approximately 78% (n 1493).
Marshallese students had a higher prevalence of food insecurity than all other racial and ethnic groups in the study. After controlling for other sociodemographic, risk and protective factors, their odds of food insecurity remained significantly higher than both non-Hispanic White and Hispanic or Latinx students.
Adolescent food insecurity among Marshallese students must be made sense of in relation to structural-level determinants that shape the distribution of vital resources such as food across racial, ethnic and foreign-born lines.
The objective of this WSSA Weed Loss Committee report is to provide quantitative data on the potential yield loss in sugar beet due to weed interference from the major sugar beet growing areas of the United States and Canada. Researchers and extension specialists who conducted research on weed control in sugar beet in the United States and Canada provided quantitative data on sugar beet yield loss due to weed interference in their regions. Specifically, data were requested from weed control studies in sugar beet from up to 10 individual studies per calendar year over a 15-yr period between 2002 and 2017. Data collected indicated that if weeds are left uncontrolled under optimal agronomic practices, growers in Idaho, Michigan, Minnesota, Montana, Nebraska, North Dakota, Ontario, Oregon, and Wyoming would potentially lose an average of 79%, 61%, 66%, 68%, 63%, 75%, 83%, 78%, and 77% of the sugar beet yield. The corresponding monetary loss would be approximately US$234, US$122, US$369, US$43, US$40, US$211, US$12, US$14, and US$32 million, respectively. The average yield loss due to weed interference for the primary sugar beet growing areas of North America was estimated to be 70%. Thus, if weeds are not controlled, growers in the United States would lose approximately 22.4 million tonnes of sugar beet yield valued at approximately US$1.25 billion, and growers in Canada would lose approximately 0.5 million tonnes of sugar beet yield valued at approximately US$25 million. The high return on investment in weed management highlights the importance of continued weed science research for sustaining high crop yield and profitability of sugar beet production in North America.
Seven half-day regional listening sessions were held between December 2016 and April 2017 with groups of diverse stakeholders on the issues and potential solutions for herbicide-resistance management. The objective of the listening sessions was to connect with stakeholders and hear their challenges and recommendations for addressing herbicide resistance. The coordinating team hired Strategic Conservation Solutions, LLC, to facilitate all the sessions. They and the coordinating team used in-person meetings, teleconferences, and email to communicate and coordinate the activities leading up to each regional listening session. The agenda was the same across all sessions and included small-group discussions followed by reporting to the full group for discussion. The planning process was the same across all the sessions, although the selection of venue, time of day, and stakeholder participants differed to accommodate the differences among regions. The listening-session format required a great deal of work and flexibility on the part of the coordinating team and regional coordinators. Overall, the participant evaluations from the sessions were positive, with participants expressing appreciation that they were asked for their thoughts on the subject of herbicide resistance. This paper details the methods and processes used to conduct these regional listening sessions and provides an assessment of the strengths and limitations of those processes.
Herbicide resistance is ‘wicked’ in nature; therefore, results of the many educational efforts to encourage diversification of weed control practices in the United States have been mixed. It is clear that we do not sufficiently understand the totality of the grassroots obstacles, concerns, challenges, and specific solutions needed for varied crop production systems. Weed management issues and solutions vary with such variables as management styles, regions, cropping systems, and available or affordable technologies. Therefore, to help the weed science community better understand the needs and ideas of those directly dealing with herbicide resistance, seven half-day regional listening sessions were held across the United States between December 2016 and April 2017 with groups of diverse stakeholders on the issues and potential solutions for herbicide resistance management. The major goals of the sessions were to gain an understanding of stakeholders and their goals and concerns related to herbicide resistance management, to become familiar with regional differences, and to identify decision maker needs to address herbicide resistance. The messages shared by listening-session participants could be summarized by six themes: we need new herbicides; there is no need for more regulation; there is a need for more education, especially for others who were not present; diversity is hard; the agricultural economy makes it difficult to make changes; and we are aware of herbicide resistance but are managing it. The authors concluded that more work is needed to bring a community-wide, interdisciplinary approach to understanding the complexity of managing weeds within the context of the whole farm operation and for communicating the need to address herbicide resistance.
OBJECTIVES/SPECIFIC AIMS: Explore perceptions of Flint stakeholders on the water crisis regarding trust and the capacity of faith and community-based organizations providing public health services to address community needs. Analyze the community’s voice shared at (1) 17 key community communications (community/congressional meetings and events), and (2) during 9 focus group sessions, in which residents, faith-based leadership and other stakeholders discuss issues and concerns on the Flint Water Crisis, and recommend ways to address them. Develop a framework that defines core theories, concepts and strategies recommended by the community to help rebuild trust and the quality of life in Flint, Michigan, and support other communities experiencing environmental stress. METHODS/STUDY POPULATION: Study population: faith-based leaders, seniors, youth, Hispanic/Latino and African American stakeholders, and others experiencing inequities in the city of Flint. Convene 9 focus group sessions (recorded and transcribed) to learn community perceptions on trust and ways to address it. Validate accuracy of the transcriptions with community consultants to reconcile any inaccurate information. Through a community engaged research (CEnR) process, review and analyze qualitative data from the 9 focus group sessions, and quantitative data from 2 surveys documenting (1) demographic backgrounds of focus group participants, and (2) their perceptions on trust and mistrust. Prepare a codebook to qualitatively analyze the focus group data summarizing community input on trust, mistrust, changes in service delivery among community and faith-based organizations, and ways to re-build trust in the city of Flint. Transcribe the community’s voice shared during 17 key events, identified by a team of community-academic stakeholders (i.e., UM Flint water course, congressional and community events, etc.), in which residents and other stakeholders discuss issues and concerns on the Flint Water Crisis, and recommend ways to address it. Qualitatively analyze the transcriptions, using a CEnR process to prepare a codebook on key themes from the community’s voice shared at these events, and recommendations on ways to address it. Compare and contrast findings between the two codebooks developed from (1) the focus group data and (2) qualitative analysis of community voice during public meetings and events. Synthesize this information into a framework of core theories, concepts and rebuilding strategies for Flint, Michigan. RESULTS/ANTICIPATED RESULTS: It is important to note many undocumented immigrant populations in Flint fear deportation and other consequences, hampering their ability to obtain service and provide community voice. Through our purposive sampling approach, we will hear from community voices not often included in narratives (i.e., seniors, youth, Hispanic/Latino residents). The presentation will present findings documenting levels of trust and mistrust in the city of Flint; and a framework of recommendations, core theories and concepts on ways to reduce, rebuild and eliminate stress that will be helpful to other communities experiencing distress. DISCUSSION/SIGNIFICANCE OF IMPACT: To our knowledge, levels of trust and mistrust in Flint have not been documented thus far. We will compare and contrast common themes presented by the community at public meetings and events with themes presented in our focus group effort on trust. Faith and community-based providers were among the first responders to the Flint Water Crisis. The effort will also share perceptions on changes in public health service delivery, and observations on preparedness for these roles that occurred among community and faith-based providers. Finally, the effort will (1) support the design of a research agenda, (2) define a framework of core theories, concepts and recommendations developed by the community to help rebuild trust in Flint, Michigan; and (3) support other communities addressing environmental distress.
Minimal efficacy differences have been found between cognitive behavioral therapy (CBT) and psychodynamic therapies for depression, but little is known about patient characteristics that might moderate differential treatment effects. We aimed to generate hypotheses regarding such potential prescriptive factors.
We conducted post-hoc model-based recursive partitioning analyses alongside a randomized clinical trial comparing the efficacy of CBT and short-term psychodynamic supportive psychotherapy (SPSP). Severely depressed patients received additional antidepressant medication. We included 233 adults seeking treatment for a major depressive episode in psychiatric outpatient clinics, who completed post-treatment assessment. Post-treatment mean Hamilton Depression Rating Scale scores constituted the main outcome measure.
While treatment differences (CBT v. SPSP) were minimal in the total sample of patients (d = 0.04), model-based recursive partitioning indicated differential treatment efficacy in certain subgroups of patients. SPSP was found more efficacious among moderately depressed patients receiving psychotherapy only who showed low baseline co-morbid anxiety levels (d = −0.40) and among severely depressed patients receiving psychotherapy and antidepressant medication who reported a duration of the depressive episode of ⩾1 year (d = −0.31), while CBT was found more efficacious for such patients reporting a duration <1 year (d = 0.83).
Our findings are observational and need validation before they can be used to guide treatment selection, but suggest that knowledge of prescriptive factors can help improve the efficacy of psychotherapy for depression. Depressive episode duration and co-morbid anxiety level should be included as stratification variables in future randomized clinical trials comparing CBT and psychodynamic therapy.
A patient with no risk factors for malaria was hospitalized in New York City with Plasmodium falciparum infection. After investigating all potential sources of infection, we concluded the patient had been exposed to malaria while hospitalized less than 3 weeks earlier. Molecular genotyping implicated patient-to-patient transmission in a hospital setting.
Infect. Control Hosp. Epidemiol. 2015;37(1):113–115
Coffee is a relatively rich source of chlorogenic acids (CGA), which, as other polyphenols, have been postulated to exert preventive effects against CVD and type 2 diabetes. As a considerable proportion of ingested CGA reaches the large intestine, CGA may be capable of exerting beneficial effects in the large gut. Here, we utilise a stirred, anaerobic, pH-controlled, batch culture fermentation model of the distal region of the colon in order to investigate the impact of coffee and CGA on the growth of the human faecal microbiota. Incubation of coffee samples with the human faecal microbiota led to the rapid metabolism of CGA (4 h) and the production of dihydrocaffeic acid and dihydroferulic acid, while caffeine remained unmetabolised. The coffee with the highest levels of CGA (P< 0·05, relative to the other coffees) induced a significant increase in the growth of Bifidobacterium spp. relative to the control vessel at 10 h after exposure (P< 0·05). Similarly, an equivalent quantity of CGA (80·8 mg, matched with that in high-CGA coffee) induced a significant increase in the growth of Bifidobacterium spp. (P< 0·05). CGA alone also induced a significant increase in the growth of the Clostridium coccoides–Eubacteriumrectale group (P< 0·05). This selective metabolism and subsequent amplification of specific bacterial populations could be beneficial to host health.
Nearly 10% of the world's total forest area is formally owned by communities and indigenous groups, yet knowledge of the effects of decentralized forest management approaches on conservation (and livelihood) impacts remains elusive. In this paper, the conservation impact of decentralized forest management on two forests in Tanzania was evaluated using a mixed method approach. Current forest condition, forest increment and forest use patterns were assessed through forest inventories, and changes in forest disturbance levels before and after the implementation of decentralized forest management were assessed on the basis of analyses of Landsat images. This biophysical evidence was then linked to changes in actual management practices, assessed through records, interviews and participatory observations, to provide a measure of the conservation impact of the policy change. Both forests in the study were found to be in good condition, and extraction was lower than overall forest increment. Divergent changes in forest disturbance levels were in evidence following the implementation of decentralized forest management. The evidence from records, interviews and participatory observations indicated that decentralized management had led to increased control of forest use and the observed divergence in forest disturbance levels appeared to be linked to differences in the way that village-level forest managers prioritized conservation objectives and forest-based livelihood strategies. The study illustrates that a mixed methods approach comprises a valid and promising way to evaluate impacts of conservation policies, even in the absence of control sites. By carefully linking policy outcomes to policy outputs, such an approach not only identifies whether such policies work as intended, but also potential mechanisms.
The 2011 bombing in Libya by Western nations occasioned renewed debate and concern about armed humanitarian intervention and the doctrine of “Responsibility to Protect” (RtoP). This book is a collection of chapters on many of the important moral and legal issues involved. All the chapters are original contributions, written specifically for this volume. The chapters are by leading international thinkers from Australia, Canada, France, the United Kingdom, and the United States.
The question of military intervention for humanitarian purposes has become a major focus for international law, the United Nations, regional organizations such as NATO, and the foreign policies of nations. The chapters reflect the latest ideas of the authors on this timely international issue – one that continues to evolve in the quest for reasonable global governance.
A number of the chapters present perspectives on the moral rationale for armed humanitarian intervention (AHI). Others focus on normative aspects of the practice - including critical views of AHI, the problem of abuse and needed limitations, the future viability of RtoP and some of its problematic implications, the possibility of AHI providing space for peaceful political protest, and how AHI might be integrated with post-war justice.
I wish to thank all the authors for their contributions to this volume and, in some cases, their work on revisions. Special thanks go to Hilary Gaskin of Cambridge University Press and to her assistant, Anna Lowe, for their advice, patience, and valuable help in the preparation of this volume. I am especially grateful to my wife, Dr. Mary Ann Scheid, for her support - and quiet tolerance during episodes of absentmindedness or grouchiness.