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This study aimed to investigate general factors associated with prognosis regardless of the type of treatment received, for adults with depression in primary care.
We searched Medline, Embase, PsycINFO and Cochrane Central (inception to 12/01/2020) for RCTs that included the most commonly used comprehensive measure of depressive and anxiety disorder symptoms and diagnoses, in primary care depression RCTs (the Revised Clinical Interview Schedule: CIS-R). Two-stage random-effects meta-analyses were conducted.
Twelve (n = 6024) of thirteen eligible studies (n = 6175) provided individual patient data. There was a 31% (95%CI: 25 to 37) difference in depressive symptoms at 3–4 months per standard deviation increase in baseline depressive symptoms. Four additional factors: the duration of anxiety; duration of depression; comorbid panic disorder; and a history of antidepressant treatment were also independently associated with poorer prognosis. There was evidence that the difference in prognosis when these factors were combined could be of clinical importance. Adding these variables improved the amount of variance explained in 3–4 month depressive symptoms from 16% using depressive symptom severity alone to 27%. Risk of bias (assessed with QUIPS) was low in all studies and quality (assessed with GRADE) was high. Sensitivity analyses did not alter our conclusions.
When adults seek treatment for depression clinicians should routinely assess for the duration of anxiety, duration of depression, comorbid panic disorder, and a history of antidepressant treatment alongside depressive symptom severity. This could provide clinicians and patients with useful and desired information to elucidate prognosis and aid the clinical management of depression.
Debate about the nature of climate and the magnitude of ecological change across Australia during the last glacial maximum (LGM; 26.5–19 ka) persists despite considerable research into the late Pleistocene. This is partly due to a lack of detailed paleoenvironmental records and reliable chronological frameworks. Geochemical and geochronological analyses of a 60 ka sedimentary record from Brown Lake, subtropical Queensland, are presented and considered in the context of climate-controlled environmental change. Optically stimulated luminescence dating of dune crests adjacent to prominent wetlands across North Stradbroke Island (Minjerribah) returned a mean age of 119.9 ± 10.6 ka; indicating relative dune stability soon after formation in Marine Isotope Stage 5. Synthesis of wetland sediment geochemistry across the island was used to identify dust accumulation and applied as an aridification proxy over the last glacial-interglacial cycle. A positive trend of dust deposition from ca. 50 ka was found with highest influx occurring leading into the LGM. Complexities of comparing sedimentary records and the need for robust age models are highlighted with local variation influencing the accumulation of exogenic material. An inter-site comparison suggests enhanced moisture stress regionally during the last glaciation and throughout the LGM, returning to a more positive moisture balance ca. 8 ka.
The first demonstration of laser action in ruby was made in 1960 by T. H. Maiman of Hughes Research Laboratories, USA. Many laboratories worldwide began the search for lasers using different materials, operating at different wavelengths. In the UK, academia, industry and the central laboratories took up the challenge from the earliest days to develop these systems for a broad range of applications. This historical review looks at the contribution the UK has made to the advancement of the technology, the development of systems and components and their exploitation over the last 60 years.
This chapter examines further changes in elite honor and shame in the Eastern Han. First, it traces the elevation of writing, earlier treated as consolation for a failed political career or entertainment that demeaned the author. During the late Western and Eastern Han, several writers invoked the ideal of the hermit to justify a life of retirement devoted to study and writing. Historical figures such as Confucius or the Duke of Zhou were portrayed as writers, as were the hidden sages of the Zhuangzi. This facilitated new genres—funeral inscription, critical essay, and shorter verse forms for self-expression—where the late Han sought honor through writing. Second, it examines the emergence in the late Han of “factions (dang ?)” defined in part through the practice of “pure discussion (qing yi ??).” These groups, like the newly celebrated writers, cited the ideal of “social eremitism” to justify refusing government offices. They criticized eunuchs and imperial affines, as well as leading officials and scholars who still served the state.
This chapter examines the role of honor and shame in defining the warrior nobility that dominated the valleys of the Yellow and Yangzi Rivers in the early Eastern Zhou (770 - ca. 500 BCE). In this society honor reflected one’s hereditary place in the hierarchy of nobility, and also one’s heroism or success in battle. Shame was primarily a matter of failing to exhibit such heroism. Such honor was entirely masculine, and its two aspects were frequently in conflict, as ascribed status was established by seniority, while the heroism was often a hallmark of youth. This personal honor gained through heroism, which often figured in overthrowing a ruler or destroying a state, is our earliest example of constituting a public order separate from the formal political realm, and how such alternate honor helped to transform the social order.
This monograph has traced how the changing language of honor and shame helped to articulate and justify the transformations of Chinese society between the Warring States and the end of the Han dynasty. This role was made possible by the fact, demonstrated by previous studies, that the honor–shame discourse justified the actions of diverse and potentially rival groups, that groups thus formed often furthered significant social changes, and that honor was particularly important to motivate actions for a public good by people who are not formally part of the state. Over the centuries of early China, the formally recognized political order was intertwined with groups articulating alternative models of honor, groups who both participated in the existing order (without formal recognition) and whose visions of what was truly glorious facilitated the transition to subsequent political structures.
This chapter examines the impact of the emergence of a unified empire on the ideas about honor and shame that defined the social elite that filled state offices, and distinguished them from elite competitors. First, scholars redefined the relation between the ruler and his officials, trying to forge them into a united body where the honor of each party depended on the honor of the other. Second, people increasingly granted status to several forms of intellectual expertise. Masters of the classical language received positions and increasing prestige for their skills. Similarly, titularly low officials who mastered legal texts secured considerable power, and claimed a higher status. Finally, Sima Qian claimed the right, patterned on Confucius, to pass judgments that honored or shamed those about whom he wrote. This developed the tension between scholars and the ruler that had emerged in the Warring States. The chapter also examines how the increasing merger of intellectuals and powerful families was reflected in tensions between the claims of scholarship and careers, and devotion to the family. Han authors carried forward the Warring States discourse distinguishing a true elite that worked for honor or morality, while rejecting conventional devotion to material wealth.
This chapter examines other aspects of the shifting structure of honor that defined Han society. First, it traces the evolution of the bravo (xia) associations in local communities. In the Western Han these were defined by killing or dying for one’s fellows, insisting on honoring one’s word, and devotion to duty. In the Eastern Han, the xia were increasingly defined through forming social networks—often including officials and nobles—in place of the violence that had been central. The chapter also examines how the family was increasingly declared to be both honorable and politically significant. Locally powerful families increasingly claimed the status of scholar or “man of service (shi),” and secured recognition as authorities in their communities. Thus kin-based elements of local society that were not formally part of the state became crucial to its functioning, and remained so in all later empires in continental East Asia. The importance of honor to these families was articulated in the emergent genre of the funerary inscription, which claimed to bestow immortal fame and celebrated the new ideal type of the retired social hermit who served and morally transformed his local community.
This book traces how a discourse of honor and shame helped create the imperial state in China. Through examining changing claims to honor, it studies Warring States articulations of new social roles and networks, early imperial redefinitions of the state’s power and its agents’ status, and how groups not employed by the state asserted a status that matched or exceeded that attributed to the bureaucracy. Such groups also denounced as shameful the elite pursuits of wealth or high office that motivated those who constituted the formal state and political elites. These groups included scholars, hermits, bravoes, writers, and locally powerful families, and, while not formally part of the state-defined public realm, in practice they became essential to the functioning of the imperial order. The roles that they played, and the language in which these were justified, came to define a non-state public realm which remained in permanent tension with the imperial government. Thus the evolving language of honor and shame allows us to move beyond a focus on the court and bureaucracy to achieve a more complete picture of Han imperial state and society.
The Warring States polity that emerged through the destruction of the old nobility and their segmentary polity was centered around an increasingly powerful autocrat, and based on peasants who paid taxes and provided military service. These two poles were linked by bureaucrats who registered the population and extracted taxes and services, and courtiers or counselors who assisted the ruler. States grew by swallowing up others, until only seven or eight remained, in which most peasants served in the armies. In Qin state, and probably others, this culminated in a state order that ranked the entirety of the free peasant population on the basis of service. Received texts and archaeologically-recovered documents show that the ranking of the population in this hierarchy of titles became fundamental to the legal and administrative orders that defined the place of the individual. Thus new ideas of honor and shame, elaborated in legal codes and administrative practices, were fundamental to the new states.
The next two chapters examine changes in the honor-shame discourse in the Warring States period (ca. 500 – 220 BCE), when larger, territorial states replaced the warrior aristocracy with bureaucratic administrators and peasant soldiers. Re-structuring Warring States society entailed forming new groups through elective ties of comradeship or discipleship and of devotion to political superiors. The honor/shame complex defined all these ties. This chapter traces the development of ideas about honor outside of ascribed status and the formal state order. These ideas were articulated by the earliest Chinese critical thinkers, who formed around the figure of Confucius. Defining themselves against conventional values, they claimed honor derived from devotion to study and virtues. They also argued that what others regarded as shameful, low status or poverty, could demonstrate a higher honor that refused to curry favor or pursue wealth. Although they sought rulers’ patronage, and offered them advice, they rejected serving those who refused the virtues they espoused, thus proving their true honor. Several rulers granted such men titles and stipends that did not entail government service. Finally, claims to honor in this period marked the emergence of networks of patrons and clients, as well as those formed by bravoes.
The Rapid ASKAP Continuum Survey (RACS) is the first large-area survey to be conducted with the full 36-antenna Australian Square Kilometre Array Pathfinder (ASKAP) telescope. RACS will provide a shallow model of the ASKAP sky that will aid the calibration of future deep ASKAP surveys. RACS will cover the whole sky visible from the ASKAP site in Western Australia and will cover the full ASKAP band of 700–1800 MHz. The RACS images are generally deeper than the existing NRAO VLA Sky Survey and Sydney University Molonglo Sky Survey radio surveys and have better spatial resolution. All RACS survey products will be public, including radio images (with
15 arcsec resolution) and catalogues of about three million source components with spectral index and polarisation information. In this paper, we present a description of the RACS survey and the first data release of 903 images covering the sky south of declination
made over a 288-MHz band centred at 887.5 MHz.
In this major new study, Mark Edward Lewis traces how the changing language of honor and shame helped to articulate and justify transformations in Chinese society between the Warring States and the end of the Han dynasty. Through careful examination of a wide variety of texts, he demonstrates how honor-shame discourse justified the actions of diverse and potentially rival groups. Over centuries, the formally recognized political order came to be intertwined with groups articulating alternative models of honor. These groups both participated in the existing order and, through their own visions of what was truly honourable, paved the way for subsequent political structures. Filling a major lacuna in the study of early China, Lewis presents ways in which the early Chinese empires can be fruitfully considered in comparative context and develops a more systematic understanding of the fundamental role of honor/shame in shaping states and societies.