To save 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 saving content to .
To save 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 saving to your Kindle.
Note you can select to save to either the @free.kindle.com or @kindle.com variations.
‘@free.kindle.com’ emails are free but can only be saved 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.
Background: Parkinson’s disease (PD) is the second most common neurodegenerative disorder worldwide. Oral medications for control of motor symptoms are the mainstay of treatment however, as the disease progresses, patients with PD may develop dysphagia or other medical illnesses that prohibit them from safely taking oral medications. Currently there are no clinical guidelines for managing distressing motor symptoms in patients with PD and severe dysphagia, which can therefore be quite challenging. Methods: A scoping review using MEDLINE, EMBASE, CENTRAL, CINAHL, AgeLine and Psyc INFO databases (1946-2021) was conducted. Articles examining PD with dysphagia in palliative care or at end-of-life were included. Studies that included patients who were also on oral PD medications or received device-aided therapy were excluded. Results: Of 3836 articles screened for title and abstract, 274 were selected for full text review, and 20 articles were finally selected for data extraction. These included five case reports, one retrospective cohort study, one book chapter and 13 narrative reviews. Conclusions: There are very few articles addressing the issue of treatment of patients with advanced PD who are unable to take oral medications. Although rotigotine patch and apormorphine injections are most frequently recommended, there are no clinical trials in this patient population to support those recommendations.
Historically, access to contraception has been supported in a bipartisan way, best exemplified by consistent congressional funding of Title X—the only federal program specifically focused on providing affordable reproductive health care to American residents. However, in an era of partisan polarization, Title X has become a political and symbolic pawn, in part because of its connection to family planning organizations like Planned Parenthood. The conflicts around Title X highlight the effects of intertwining abortion politics and contraception policy, particularly as they relate to reproductive justice and gendered policy making. Family planning organizations like Planned Parenthood have responded to these battles by bowing out of the Title X network. To what extent have contraception deserts—places characterized by inequitable access to Title X—developed or expanded in response to policy changes related to contraception and reproductive health? What is the demographic makeup of these spaces of inequality? We leverage data from the Office of Population Affairs and the U.S. Census Bureau and use the integrated two-step floating catchment area method to illustrate the effects of a major change in the Title X network in 10 states. Our results reveal the widespread human ramifications of increasing constraints on family planning organizations as a result of quiet but insidious federal bureaucratic rule changes.
A patchwork of policies exists across the United States. While citizens’ policy preferences in domains such as the criminal legal system, gun regulations/rights, immigration, and welfare are informed by their political predispositions, they are also shaped by the extent to which policy targets are viewed as deserving. This article centres the idea that collective evaluations matter in policymaking, and it ascertains whether subnational levels of deservingness evaluations of several target groups differ across space to illuminate the link between these judgements and state policy design. We leverage original survey data and multilevel regression and poststratification to create state-level estimates of deservingness evaluations. The analyses elucidate the heterogeneity in state-level deservingness evaluations of several politically relevant groups, and they pinpoint a link between these social reputations and policy design. The article also delivers a useful methodological tool and measures for scholars of state policy design to employ in future research.
Irregular hospital discharge is highly prevalent among people admitted to hospital for mental health reasons. No study has examined the relationship between irregular discharge, post-discharge mortality and treatment setting (i.e. mortality after patients are discharged from acute in-patient or residential mental health settings).
To understand the relationship between irregular discharge and mortality among patients discharged from acute in-patient and residential settings.
A retrospective study was conducted in members of the US veteran population discharged from acute in-patient or residential settings of the US Department of Veterans Affairs between 2003 and 2018. Multivariate Cox proportional hazards were used to evaluate associations between irregular discharge and suicide, external-cause (as defined by ICD-10 Codes: V01-Y98) and all-cause mortality in the first 30-, 90- and 180-days post-discharge.
There were over 1.5 million mental health discharges between 2003 and 2018. Patients with an irregular discharge were at increased risk for suicide, external-cause and all-cause mortality in the first 180 days after discharge. In the first 30 days after discharge, patients with irregular discharge had more than three times greater suicide risk than patients with regular discharge (adjusted hazard ratio (HR) = 3.41, 95% CI 2.21–5.25). Suicide risk was higher among patients with irregular discharge in the first 30 days after acute in-patient discharge (adjusted HR = 1.55, 95% CI 1.11–2.16). In both settings, the mortality risk associated with irregular discharge attenuated but remained elevated within 90 and 180 days.
Irregular discharge after an acute in-patient or residential stay poses a large risk for mortality soon after discharge. Clinicians must identify effective interventions to mitigate harms associated with irregular discharge in these settings.
Prior research has shown that sipping of alcohol begins to emerge during childhood and is potentially etiologically significant for later substance use problems. Using a large, community sample of 9- and 10-year-olds (N = 11,872; 53% female), we examined individual differences in precocious alcohol use in the form of alcohol sipping. We focused explicitly on features that are robust and well-demonstrated correlates of, and antecedents to, alcohol excess and related problems later in the lifespan, including youth- and parent-reported externalizing traits (i.e., impulsivity, behavioral inhibition and activation) and psychopathology. Seventeen percent of the sample reported sipping alcohol outside of a religiously sanctioned activity by age 9 or 10. Several aspects of psychopathology and personality emerged as small but reliable correlates of sipping. Nonreligious sipping was related to youth-reported impulsigenic traits, aspects of behavioral activation, prodromal psychotic-like symptoms, and mood disorder diagnoses, as well as parent-reported externalizing disorder diagnoses. Religious sipping was unexpectedly associated with certain aspects of impulsivity. Together, our findings point to the potential importance of impulsivity and other transdiagnostic indicators of psychopathology (e.g., emotion dysregulation, novelty seeking) in the earliest forms of drinking behavior.
Physical evidence of weapon trauma in medieval burials is unusual, and evidence for trauma caused by arrowheads is exceptionally rare. Where high frequencies of traumatic injuries have been identified, this is mainly in contexts related to battles; it is much less common in normative burials. Osteological analysis of one context from an assemblage of disarticulated and commingled human bones recovered from a cemetery associated with the thirteenth-century Dominican friary in Exeter, Devon, shows several instances of weapon trauma, including multiple injuries caused by projectile points. Arrow trauma is notoriously difficult to identify, but this assemblage shows that arrows fired from longbows could result in entry and exit wounds in the skull not incomparable to modern gunshot wounds. Microscopic examination of the fracture patterns and spalling associated with these puncture wounds provides tentative evidence that medieval arrows were fletched to spin clockwise. These results have profound implications for our understanding of the power of the medieval longbow, for how we recognise arrow trauma in the archaeological record and for our knowledge of how common violent death and injury were in the medieval past, and how and where casualties were buried.
We consider the numerical solution of competitive exothermic and endothermic reactions in the presence of a chaotic advection flow. The resulting behaviour is characterized by a strong dependence on the competitive reaction history. The burnt temperature is not immediately connected to simple enthalpy calculations, so there is a subtlety in the interplay between the major parameters, notably the Damköhler number, the ratio of the heats of exothermic and endothermic reactions, as well as the ratio of their respective activation energies. This paper seeks to explore the way these parameters affect the steady states of these reaction fronts and their stability.
Addictive and psychiatric disorders are a significant barrier to retention in medical care leading to worse outcomes. As part of an HIV care expansion project, the H-STAR intervention was designed to treat substance use and psychiatric disorders for minority patients receiving co-located HIV medical care.
The intervention aim was to increase access to treatment for substance abuse and psychiatric disorders in minority HIV+ patients and reduce substance use.
The H-STAR primary objective was to offer substance and psychiatric evaluation and treatment with an integrated treatment model.
All participants in H-STAR underwent substance abuse screening and evaluation, using DSM-IV-TR criteria. Substance use was measured on the Government Performance Reports Act (GPRA) form at baseline and 6 months. Intensive outpatient treatment (IOP) using the Matrix Model as the behavioral intervention was available to all patients. All patients were offered and scheduled psychiatric evaluation and treatment with an onsite psychiatrist.
Of 123 enrolled persons with both baseline and 6 month GPRAs, the prevalence of substance abuse/dependence disorders were as follows: Alcohol: 32 (24.2%); Opiate: 54 (43.9%); Cocaine: 47(38.2%); and Marijuana: 26(21.1%). Thirty (22.1%) completed IOP. At 6 month follow-up there was statistically significant reduced use of alcohol, heroin and cocaine. Of 136 enrolled participants, seventy-five (55.1%) had psychiatric evaluations; 53 (70.7%) received medication management.
There was a significant reduction in all substance use; cocaine use remained the most prevalent. Despite open access to psychiatric evaluation, not all patients completed evaluation in spite of multiple attempts to reschedule.
California has a large population of people experiencing homelessness (PEH) that is characterised by a high proportion of people who are unsheltered and chronically homeless. PEH are at increased risk of communicable diseases due to multiple, intersecting factors, including increased exposures, comorbid conditions including substance use disorder and mental illness and lack of access to hygiene and healthcare facilities. Data available for several communicable diseases show that PEH in California experiences an increased burden of communicable diseases compared to people not experiencing homelessness. Public health agencies face unique challenges in serving this population. Efforts to reduce homelessness, increase access to health care for PEH, enhance data availability and strengthen partnerships among agencies serving PEH can help reduce the disparity in communicable disease burden faced by PEH.
Although many scholars who study the role of racial animus in Americans’ political attitudes and policy preferences do so to help us understand national-level politics, (racialized) policy is largely shaped at the state level. States are laboratories of policy innovation whose experiments can exacerbate or ameliorate racial inequality. In this article, we develop state-level scores of racial resentment. By using linear multilevel regression and poststratification weighting techniques and by linking nationally representative survey data with US Census data, we create time-varying, dynamic state-level estimates of racial resentment from 1988 to 2016. These measures enable us to explore the extent to which subnational levels of racial attitudes fluctuate over time and to provide a comparative analysis of state-level racial resentment scores across space and time. We find that states’ levels of racial animus change slowly, with some exhibiting increases over time while others do just the opposite. Southern states’ reputation for having the highest levels of racial resentment has been challenged by states across various regions of the United States. Many states had their lowest levels of symbolic racism decades ago, contrary to the traditional American narrative of racial progress.