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Treatment-resistant schizophrenia is a major disabling illness which often proves challenging to manage in a secondary care setting. The National Psychosis Unit (NPU) is a specialised tertiary in-patient facility that provides evidence-based, personalised, multidisciplinary interventions for complex treatment-resistant psychosis, in order to reduce the risk of readmission and long-term care costs.
This study aimed to assess the long-term effectiveness of treatment at the NPU by considering naturalistic outcome measures.
Using a mirror image design, we compared the numbers of psychiatric and general hospital admissions, in-patient days, acuity of placement, number of psychotropic medications and dose of antipsychotic medication prescribed before and following NPU admission. Data were obtained from the Clinical Records Interactive Search system, an anonymised database sourced from the South London and Maudsley NHS Trust electronic records, and by means of anonymous linkage to the Hospital Episode Statistics system.
Compared with the 2 years before NPU admission, patients had fewer mental health admissions (1.65 ± 1.44 v. 0.87 ± 0.99, z = 5.594, P < 0.0001) and less mental health bed usage (335.31 ± 272.67 v. 199.42 ± 261.96, z = 5.195 P < 0.0001) after NPU admission. Total in-patient days in physical health hospitals and total number of in-patient days were also significantly reduced (16.51 ± 85.77 v. 2.83 ± 17.38, z = 2.046, P = 0.0408; 351.82 ± 269.09 v. 202.25 ± 261.05, z = 5.621, P < 0.0001). The reduction in level of support required after treatment at the NPU was statistically significant (z = −8.099, P < 0.0001).
This study demonstrates the long-term effectiveness of a tertiary service specialising in treatment-resistant psychosis.
This article is concerned with the colonial state as a producer, consumer, and regulator of print. Propaganda and censorship may represent two extremes in the management of a colonial public sphere. Censorship was an interactive and negotiated process—one whose successful management was in the interest of both the censoring agents and those censored. One might think that censorship is a measure taken in order for communication to break down. If we imagine colonial print communication as a continuum suspended between partners that at one end desire full freedom of expression and at the other full control, absolute censorship does constitute silence, like that represented by the dramatic closure of the African press in Kenya with the Emergency of 1952. In a politicised colonial environment, like that in postwar Kenya, censorship may be understood as negotiation between colonisers and colonised on the limits of free speech. The article examines what changed in Kenya's late-colonial period in relation to the production, broadcasting, censoring, and suppression of non-European newspapers, and how the change affected the institutions and groupings that produced and received texts. More narrowly, it seeks to trace the dynamics of textual interfaces between the European print frameworks and those of the consolidated or emerging non-European publicists and publics. An examination that situates censorship in a broader context of management of discourse, of negotiation and dialogue, one that tests and goes beyond the dualism of suppression and resistance, may make it clearer why and to what extent a number of critical, anti-colonial publications were allowed to exist, and some were encouraged; and what the limits were, when opposition became unacceptable, and communication broke down.
This article is focused on a magazine called Jambo, which was published by the British East Africa Command for troops in its employ between 1942 and 1945. Jambo was an agglomeration of political articles, general interest stories, propaganda, cartoons, crosswords, and more, with many of its contributions authored (or drawn) by men serving in the Allied forces. Here, I use Jambo to consider notions of the “colonial” and “imperial” during the Second World War, exploring how the realities of racial segregation in the colonies fit awkwardly with imperial service. Jambo also permits us a window into the views of some hundreds of British servicemen, who wrote extensively about the Africans with whom they served, revealing the complexities and shifts in British perceptions of African peoples during the conflict. Jambo is unique in another respect: it also provided a forum for African troops. In few other publications—and even fewer with such wide circulation—could educated (but nonelite) African peoples reach thousands of British readers. Though their published letters and articles were few compared to those written by Jambo's British authors, African writers used the venue to critique the conditions of their military service, argue about the sort of social ordering they desired in their home communities, and create an alternate narrative of the war. Like most colonial publications, Jambo had intended audiences, but also voracious, additional, alternate publics that mediated the articles which appeared in its pages. All this suggests that we might think of the colonial public sphere as both local and global, inward and outward looking, personal and communal, and situated along a continuum between colonial and imperial contexts.
In the 1870s, Indian news editors warned their readers of a series of crises threatening India. They saw the famines, wars, and poverty that they were describing as symptoms of the same illness: Colonial governors had failed to implement an ethical system of governance, and had therefore failed to create a healthy body politic, choosing to expend energy in punishing or censoring dissent when they should have been constructing more durable civic institutions. In North India, earlier Mughal traditions of political philosophy and governance offered a template to critique the current state. In drawing on these traditions, editors linked multiple registers of dissent, from simple ‘fables’ about emperors to more sophisticated arguments drawn from newly reinterpreted akhlaq texts, creating a print record of the multilingual, multivalent literary and oral worlds of Indian political thought. The figures of the Mughal emperors Akbar and Aurangzeb, representing the zenith and nadir of Mughal sovereignty, in turn linked popular and learned discussions on statecraft, good governance, and personal responsibility in an age of crisis. The press itself became a meeting point for multivalent discourses connecting South Asian publics, oral and literate, in their exploration of the nature of just rule in the context of empire, calling, in the process, new ‘publics’ into being.
A growing literature explores the varying role of print media in the colonial world and the new types of publics such newspapers and periodicals produced. However, this literature has tended to focus on specific regions, and has often sidestepped the larger question of how to conceptualise the relationship between print media and colonial rule. While some have used the term ‘colonial public sphere’ or ‘colonial publics,’ others have preferred to avoid these terms and instead thought in terms of multiple and overlapping publics. What this literature has shown is that a single analytic model for analysing public spaces of discourse is not usable. In this Introduction to our Special Issue we propose a new framework for studying the publics created through print media in the colonial world. We outline a set of four factors – addressivity, performativity, materiality and periodicity – that can be applied to specific historical case studies. We then explain how the issue as a whole models this methodology as a means to analyse how print media (as one medium within the public sphere) functioned in specific colonial and semi-colonial spaces around the world.
Over sixteen months in 1857 and 1858, Walter Buller produced a weekly newspaper for Māori of the Wellington region in their own language. Although he was the son of a Wesleyan missionary and an official interpreter, the niupepa was neither a church nor a government publication, although it promoted discourses favoured by both. A number of niupepa had preceded Buller's Te Karere o Poneke, the first appearing in 1842, but his paper was distinctive in the sizable platform he provided for correspondence. Over half of the items printed comprised letters from Māori, many of them commenting on, and occasionally critiquing the colonial milieu.
The concept of “public sphere” is heavily theorized, often postulated in acultural terms (although suspiciously European in form) and it is debatable if Te Karere o Poneke's readership and their engagement with the textual discourse meet the theory's required criteria of constituting a public sphere. New Zealand was annexed to the British Empire in 1840, meaning that by 1857 colonization was still a relatively new phenomenon, but with substantial immigration and a developing infrastructure, change was both extensive and dynamic. According to the theory, it may be difficult to apply the concept of “public sphere” to Māori anytime during the changing contexts of nineteenth-century colonialism, and indeed other colonised cultures for whom the advent of literacy, Christianity, market economy and colonial administration had been sudden and unexpected. Of course this does not mean that Māori lacked a voice, at times critical. Using Te Karere o Poneke as a case study, this essay argues that Wellington Māori of 1857 do not readily fit the Western model of the “public sphere”, but they nevertheless utilized the discursive spaces available to them to discuss and evaluate the world they now encountered.
This article seeks to establish the value of the concept of cosmotopia to historians of intercultural connections through presenting a case study of the Calcutta Unitarian Committee, which was active between 1821 and 1828. In tandem, it aims to enhance understanding of the origins of one particularly sustained set of intercultural connections: the interfaith network which developed between an influential group of Hindu religious and social reformers, the Brahmo Samaj, and western Unitarian Christians. The article focusses on the collaboration between the two leading figures on the Committee: Rammohun Roy, the renowned founder of the Brahmo Samaj, who is often described as the Father of Modern India; and William Adam, a Scottish Baptist missionary who was condemned as the “second fallen Adam” after his “conversion” to Unitarianism by Rammohun Roy, and who went on to cofound a utopian community in the United States. It explores the Calcutta Unitarian Committee's activities within the cosmopolitan milieu of early colonial Calcutta, and clarifies its role in the emergence of the Brahmo Samaj, in the development of a unique approach to Christian mission among Unitarians, and in laying the foundations of a transnational network whose members were in the vanguard of religious innovation, radical social reform, and debates on the “woman question” in nineteenth-century India, Britain, and the United States. In conclusion, the article draws on the case study to offer some broader reflections on the relationship between utopianism, cosmopolitanism, and colonialism.
Habermas saw the public sphere as coterminous with the national space. Anderson dreamed of newspaper readers facing the same paper for breakfast forming an “imagined community,” which he saw as vital for supplementing the subjective side of nationhood. Historical evidence supports neither proposition. Both remain locked in a nation-state focused history and have to sideline large and crucial parts of the record. This article studies two early Chinese-language periodical publications characterised by their radical difference to the standard European models, the East Western Monthly Magazine (1833–1838) and the Shenbao (1872–1949), and considers the implications of these examples for dominant conceptual frameworks.
This article discusses the ways in which newsprint allowed local contributors and readers in colonial settings to think across gender, race, and other core colonial subject-positions. It also asks about the extent to which the central role of men in controlling local print networks has implications for how we conceptualise “publics” and “public spheres” in the colonial era.
This article suggests that conditions of coloniality produce a sui generis public sphere, one which contains multiple, plurilingual collective audiences, rather than a single “bourgeois public sphere” (Habermas), or a single “imagined community” (Anderson). By way of illustration, it locates diasporic Chinese publics in the colonial public sphere of British Malaya, and argues for a more analytically differentiated understanding of their constituent collectivities, or what it refers to as “we” publics. It analyses a Chinese-language newspaper, the Yik Khuan Poh, elaborating the different “we” publics convened within its pages, and emphasising the regional and translocal geographies of collective belonging that exist within the “transnational we,” which models of diaspora tend to overdetermine. In situating the Yik Khuan Poh in its temporal and spatial contexts in the early twentieth century, this article also raises questions about the character of colonial public spheres in an era of significant globality.
At the end of the eighteenth century, members of the colonial elite of the Captaincy General of Venezuela addressed a letter to the king of Spain in which they sought permission to have a printing press in the city of Caracas. In the letter, they argued that the establishment of such a press was fundamental for the economic and commercial development of the Captaincy. Months later, they learned that the permission for a printing press had been denied without further explanations. Venezuela became one of the last capital cities in colonial Spanish America to possess this technology. The lack of a printing press during this politically dynamic period moved by the Atlantic revolutions did not necessarily affect public access to reading, sharing of information, and political debate in Venezuela. Venezuela's unique geographical location, and its open and frequent connections with the Caribbean region during the Age of Revolutions allowed for the effective entrance and transit of people and written materials that spread revolutionary ideas and impressions, creating a dynamic and contested political environment. Here I argue that during the late-colonial period, semiliterate forms of knowledge transmission, partially promoted by Spanish reformism, mobilised a socially diverse public that openly debated the monarchical regime, the system of slavery, and the hierarchical socio-racial order of colonial society. The colonial public sphere in Venezuela was shaped, then, within a context of emerging socio-racial tensions and became a space of contestation and struggle, animated by the overlapping of contradictory political discourses.
This study contributes to recent debates about the character, nature, and relevance of the public sphere in the colonial world. It explores the circulation of manuscripts and ephemeral written materials, the different modes of production and reception of texts that developed in the colonial context, and an analysis of the character of the urban spaces that facilitated the performativity of texts. It thus offers a new framework for understanding the emergence of a public sphere in Venezuela, a colonial peripheral province with no printing press.
Clozapine is uniquely effective in treatment-resistant psychosis but remains underutilised, partly owing to psychotic symptoms leading to non-adherence to oral medication. An intramuscular formulation is available in the UK but outcomes remain unexplored.
This was a retrospective clinical effectiveness study of intramuscular clozapine prescription for treatment initiation and maintenance in treatment-resistant psychosis over a 3-year period.
Successful initiation of oral clozapine after intramuscular prescription was the primary outcome. Secondary outcomes included all-cause clozapine discontinuation 2 years following initiation, and 1 year after discharge. Discontinuation rates were compared with a cohort prescribed only oral clozapine. Propensity scores were used to address confounding by indication.
Among 39 patients prescribed intramuscular clozapine, 19 received at least one injection, whereas 20 accepted oral clozapine when given an enforced choice between the two. Thirty-six (92%) patients successfully initiated oral clozapine after intramuscular prescription; three never transitioned to oral. Eight discontinued oral clozapine during the 2-year follow-up, compared with 83 out of 162 in the comparator group (discontinuation rates of 24% and 50%, respectively). Discontinuation rates at 1-year post-discharge were 21%, compared with 44% in the comparison group. Intramuscular clozapine prescription was associated with a non-significantly lower hazard of discontinuation 2 years after initiation (hazard ratio 0.39, 95% CI 0.14–1.06) and 1 year after discharge (hazard ratio 0.37, 95% CI 0.11–1.24). The only reported adverse event specific to the intramuscular formulation was injection site pain and swelling.
Intramuscular clozapine prescription allowed transition to oral maintenance in an initially non-adherent cohort. Discontinuation rates were similar to patients only prescribed oral clozapine and comparable to existing literature.
About 25 years ago, it came to light that a single combinatorial property determines both an important dividing line in model theory (NIP) and machine learning (PAC-learnability). The following years saw a fruitful exchange of ideas between PAC-learning and the model theory of NIP structures. In this article, we point out a new and similar connection between model theory and machine learning, this time developing a correspondence between stability and learnability in various settings of online learning. In particular, this gives many new examples of mathematically interesting classes which are learnable in the online setting.
Our 2015-2016 ALMA 1.3 to 0.87 mm observations (resolution ~200 au) of the massive protocluster NGC6334I revealed that an extraordinary outburst had occurred in the dominant millimeter dust core MM1 (luminosity increase of 70×) when compared with earlier SMA data. The outburst was accompanied by the flaring of ten maser transitions of three species. We present new results from our recent JVLA observations of Class II 6.7 GHz methanol masers and 6 GHz excited OH masers in this region. Class II masers had not previously been detected toward MM1 in any interferometric observations recorded over the past 30 years that targeted the bright masers toward other members of the protocluster (MM2 and MM3=NGC6334F). Methanol masers now appear both toward and adjacent to MM1 with the strongest spots located in a dust cavity ~1 arcsec (1300 au) north of the MM1B hypercompact HII region. In addition, new excited OH masers appear on the non-thermal source CM2. These data reveal the dramatic effects of episodic accretion onto a deeply-embedded high mass protostar and demonstrate its ongoing impact on the surrounding protocluster.