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 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 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.
Many people who have self-harmed prefer informal sources of support or support from those with lived experience. However, little is known about whether peer support improves outcomes for people who have self-harmed or about the risks of peer support interventions in non-clinical settings.
The aims of this review were to examine the effectiveness, acceptability and potential risks of peer support for self-harm, and how these risks might be mitigated.
We searched bibliographic databases and grey literature for papers published since 2000. We included peer support for self-harm that occurred in voluntary-sector organisations providing one-to-one or group support, or via moderated online peer support forums.
Eight of the ten papers included focused on peer support that was delivered through online media. No study compared peer support with other treatments or a control group, so limited conclusions could be made about its effectiveness. Peer support for self-harm was found to be acceptable and was viewed as having a range of benefits including a sense of community, empowerment, and access to information and support. The most commonly perceived risk associated with peer support was the potential for triggering self-harm.
Our findings highlighted a range of benefits of being part of a group with very specific shared experiences. Mitigations for potential risks include organisations using professional facilitators for groups, trigger warnings for online forums, and providing regular supervision and training so that peers are prepared and feel confident to support vulnerable people while maintaining their own emotional health.
Traditional scholarship on cities has ignored the impact of warfare, except insofar as cities have been totally destroyed, such as Hiroshima and Nagasaki in World War II, or as they have been rebuilt, as Berlin was after World War II. These cities are usually treated in primarily nationalist terms, emphasizing their roles in the respective combatant nations. This chapter treats several global cities in transnational terms, noting how the effects of the specific military conflicts have secondary consequences that transgress geopolitical borders and permit us to recognize shared suffering by combatants from different nations by focusing on Camilo Mejía’s memoir of the Iraq War, The Road from ar Ramadi (2007), and Jason Hall’s film about Iraq War veterans, Thank You for Your Service (2017). Managua, San José (Costa Rica), Miami, Boston, al Ramadi, and Topeka have little in common as modern cities, but the US-led neoimperial wars in Central America and the Middle East bring all of these cities and their inhabitants together in terrifyingly similar ways. New scholarly studies of modern cities need to interpret just these transnational intersections.
Lumateperone (ITI-007) is in late-phase clinical development for schizophrenia. Lumateperone has a unique mechanism of action that modulates serotonin, dopamine, and glutamate neurotransmission. This pooled analysis of lumateperone in 3 randomized, double-blind, placebo-controlled studies was conducted to evaluate the safety and tolerability of lumateperone 42mg (ITI-007 60mg).
Data were pooled from the 3 controlled late-phase studies of lumateperone 42mg in patients with acute exacerbation of schizophrenia. Safety assessments of all patients who received at least one dose of any treatment included treatment-emergent adverse events (TEAEs), changes in laboratory parameters, extrapyramidal symptoms (EPS), and vital signs.
The safety population comprised 1,073 patients (placebo [n=412], lumateperone 42mg [n=406], risperidone [n=255]). TEAEs that occurred in the lumateperone 42mg group at a rate of ≥5% and twice placebo were somnolence/sedation (24.1% vs 10.0%) and dry mouth (5.9% vs 2.2%). Rates of discontinuation due to TEAEs with lumateperone 42mg (0.5%) were similar to placebo (0.5%) and lower than risperidone (4.7%). Mean change in weight and rates of EPS-related TEAEs were less for lumateperone 42mg and placebo patients than risperidone patients. Mean change from baseline in metabolic parameters were similar or smaller for lumateperone 42mg vs placebo. Mean changes were notably higher in risperidone patients vs lumateperone 42mg and placebo for glucose, cholesterol, triglycerides, and prolactin.
In this pooled analysis, lumateperone 42mg showed good tolerability with potential benefits over risperidone for metabolic, prolactin, and EPS risks. The only TEAE that occurred in >10% of lumateperone patients was somnolence/sedation, which was impacted by morning administration; in subsequent studies that administered lumateperone in the evening, somnolence/sedation rates were markedly reduced. These results suggest that lumateperone 42mg may be a promising new treatment for schizophrenia.
Supported by funding from Intra-Cellular Therapies, Inc.
Volumetric atrophy and microstructural alterations in diffusion tensor imaging (DTI) measures of the hippocampus have been reported in people with Alzheimer's disease (AD) and mild cognitive impairment (MCI). However, no study to date has jointly investigated concomitant microstructural and volumetric changes of the hippocampus in dementia with Lewy bodies (DLB).
A total of 84 subjects (23 MCI, 17 DLB, 14 AD, and 30 healthy controls) were recruited for a multi-modal imaging (3T MRI and DTI) study that included neuropsychological evaluation. Freesurfer was used to segment the total hippocampus and delineate its subfields. The hippocampal segmentations were co-registered to the mean diffusivity (MD) and fractional anisotropy (FA) maps obtained from the DTI images.
Both AD and MCI groups showed significantly smaller hippocampal volumes compared to DLB and controls, predominantly in the CA1 and subiculum subfields. Compared to controls, hippocampal MD was elevated in AD, but not in MCI. DLB was characterized by both volumetric and microstructural preservation of the hippocampus. In MCI, higher hippocampal MD was associated with greater atrophy of the hippocampus and CA1 region. Hippocampal volume was a stronger predictor of memory scores compared to MD within the MCI group.
Through a multi-modal integration, we report novel evidence that the hippocampus in DLB is characterized by both macrostructural and microstructural preservation. Contrary to recent suggestions, our findings do not support the view that DTI measurements of the hippocampus are superior to volumetric changes in characterizing group differences, particularly between MCI and controls.
We studied neuroinflammation in individuals with late-life, depression, as a
risk factor for dementia, using [11C]PK11195 positron emission
tomography (PET). Five older participants with major depression and 13
controls underwent PET and multimodal 3T magnetic resonance imaging (MRI),
with blood taken to measure C-reactive protein (CRP). We found significantly
higher CRP levels in those with late-life depression and raised
[11C]PK11195 binding compared with controls in brain regions
associated with depression, including subgenual anterior cingulate cortex,
and significant hippocampal subfield atrophy in cornu ammonis 1 and
subiculum. Our findings suggest neuroinflammation requires further
investigation in late-life depression, both as a possible aetiological
factor and a potential therapeutic target.
Chronic disease, mobility limitations and low physical functioning are determinants of an earlier age of retirement. Therefore, long-term population trends in these factors may have an impact on the proportion of individuals near traditional retirement age who continue to work. Our objective is to develop a projection model that accounts for trends in these factors in order to estimate the proportion of the population aged 55–74 with the capacity to participate in the labour force. We used logistic regression models to quantify how chronic disease, mobility and functional status predict labour force participation among individuals aged 55–59. Next, we obtained estimates of the population prevalence of each of these predictors for the years 2010–2050. We then used estimated coefficients from the logistic regression models to predict the age-specific probability of capacity for work up to the age of 74. We find that population capacity for work depends on trends in disability and on level of education. Future population capacity for work depends on trends in functional limitations primarily in the population with lower levels of education. Changes in functional limitations, changes in the environment, technology and social policy targeted towards individuals with lower levels of education could result in mitigation of future decreasing capacity for work in the population near retirement age.
We conducted a program of research to derive and test the reliability of a clinical prediction rule to identify high-risk older adults using paramedics’ observations.
We developed the Paramedics assessing Elders at Risk of Independence Loss (PERIL) checklist of 43 yes or no questions, including the Identifying Seniors at Risk (ISAR) tool items. We trained 1,185 paramedics from three Ontario services to use this checklist, and assessed inter-observer reliability in a convenience sample. The primary outcome, return to the ED, hospitalization, or death within one month was assessed using provincial databases. We derived a prediction rule using multivariable logistic regression.
We enrolled 1,065 subjects, of which 764 (71.7%) had complete data. Inter-observer reliability was good or excellent for 40/43 questions. We derived a four-item rule: 1) “Problems in the home contributing to adverse outcomes?” (OR 1.43); 2) “Called 911 in the last 30 days?” (OR 1.72); 3) male (OR 1.38) and 4) lacks social support (OR 1.4). The PERIL rule performed better than a proxy measure of clinical judgment (AUC 0.62 vs. 0.56, p=0.02) and adherence was better for PERIL than for ISAR.
The four-item PERIL rule has good inter-observer reliability and adherence, and had advantages compared to a proxy measure of clinical judgment. The ISAR is an acceptable alternative, but adherence may be lower. If future research validates the PERIL rule, it could be used by emergency physicians and paramedic services to target preventative interventions for seniors identified as high-risk.
An 85-year-old villager named Erieza Kintu died at Kabubu in the county of Bulemezi, kingdom of Buganda, sometime in 1965. His passing was virtually unnoticed, except by relatives and a few neighbors. Through my research trips between 1962 and 1964 had on several occasions brought me to within a few miles of his house, I never met Kintu. Yet he is one of my best sources for the history of Buganda in the 1890s. Indeed, his memory of the so called “rebellion” by Kabaka Mwanga against the British in 1897 is the single best source I know, particularly valuable as an “insider” eyewitness participant. Even more importantly, unlike the earlier “official” histories of Mwanga's uprising, Kintu's view is from the point of the losers in the conflict—those who had resisted the new order of Christianity, private land tenure, and protectorate status within the British empire.
As so often happens with the vanquished, their history was suppressed by the victors, who—through the control of schooling and the printing press— ensured that only their own version of the conflict would become history. Yet somehow, at the age of almost seventy years the non-literate Erieza Kintu managed to dictate his oral memoirs to the manager of the Baganda Cooperative Society Press, and the result was Sulutani Anatoloka, a printed pamphlet that went on sale in Kampala priced one shilling a copy. After a few days no doubt the small edition was sold out and disappeared from view. Fortunately, one copy wound up in the hands of a prominent anthropologist from the University of Chicago, Lloyd Fallers, who was director of the East African Institute of Social Research at Makerere University in the early 1950s. Years later, when Fallers returned to Chicago, he brought back the pamphlet and offered me a photocopy, which I translated from Luganda into English in 1964. At that time I knew nothing about the author, except what was printed in his memoir covering the years from 1892 to 1899, nor did I know the circumstances surrounding the publication, or even the date when it had been printed. So here was a mysterious, unique, and potentially invaluable historical source—if only one could investigate its provenance.
On 24 May 1966 the 500-year-old kingdom of Buganda came to an end. That was the day that Prime Minister Obote sent Colonel Idi Amin to attack the Mengo palace of Kabaka Frederick Mutesa, who was also the President of Uganda. A 120-man bodyguard defended the Kabaka; Amin had automatic and heavy weapons. Nevertheless, Obote was much annoyed that the palace held out against Amin's troops. An audience watched the battle from nearby hilltops, where expatriates and others brought out folding chairs, until a mid-afternoon thunderstorm sent everyone scurrying for cover. The Kabaka used this interruption to scale the rear wall of Mengo palace, where he hailed a passing taxicab and set off for Burundi and ultimately exile in London. Obote divided Buganda into two separate districts (East Mengo and West Mengo), promoted Amin, and gave him the palace as a barracks for his “paratroop” battalion, and more importantly also gave him Buganda's legislative hall—the Bulange—to become Amin's national military headquarters.
The casualties in the “battle of Mengo” were certainly few in number compared to the destruction Amin would wreak after his coup in 1971. But one invisible casualty of the Bulange occupation was especially significant for historians. The Bulange was not only the seat of the Lukiiko, the Ganda legislature, it was also the storage building for the Buganda government archives, which went back to the 1890s, and were still well organized anu maintained in 1956-58 when Peter Gutkind made use of them for his doctoral research. By 1963 storage space was becoming scarce when Rowe made several visits to Shaykh Ali Kulumba, the Speaker of the Lukiiko. Shaykh Kulumba opened up cupboards and closets packed with archival folders from floor to ceiling. Clearly the archives were still being preserved, but organization and access had suffered. Three years later, when Amin occupied the Bulange, he simply destroyed the entire archive—the historical record of sixty years of Buganda government ceased to exist.
Herbivorous and deposit-feeding gastropods are a major component of archaeological shell middens worldwide. They provide a wealth of information about subsistence, economy, environment, and climate, but are generally considered to be less than ideal for radiocarbon dating because they can ingest sediment while they graze, inadvertently consuming terrestrial carbon in the process. However, few studies of 14C activity in herbivores or deposit-feeding gastropods have been conducted into this diverse range of animals that inhabit many environmental niches. Here, we present results investigating 14C variability in shells belonging to the families Strombidae and Potamididae from the Bogi 1 archaeological site, Caution Bay, southern coastal Papua New Guinea (PNG). These shells make up 39.3% of the shell MNI in the excavation units studied and some of these species are the most common taxa of neighboring sites. It would therefore be advantageous to establish if there are any 14C offsets associated with such animals, and identify those that can give reliable calendar ages. Our methodology combines a high-resolution excavation protocol, selection of short-lived samples identified to species level, and a triisotope approach using 14C, δ13C, and δ18O to evaluate the source of variability in shells. Our results indicate that considerable variation exists between different species of Strombidae with some inhabiting muddier environments that act as sinks for limestone-derived sediments with depleted 14C content. The magnitude of variation is, however, overshadowed by that measured in the mudwhelk, Cerithidea largillierti, which has the largest spread in 14C of any shellfish studied so far at Caution Bay. This animal ingests sediment within the estuary that contains 14C derived from both enriched and depleted sources.
Traditional approaches to the “war novel” and “the literature of war” have focused mostly on cultural reactions to specific wars, accepting a causal relationship that privileges the historical event over its representation. The Civil War takes place, and we have the cultural “response.” Edmund Wilson's famous Patriotic Gore: Studies in the Literature of the American Civil War (1962) is a good example of this approach. Since Paul Fussell's The Great War and Modern Memory (1975), however, the relationship between “war literature” and the “event” of warfare has been treated in a more dialectical manner. Literature and other cultural production may predict war, warn us away from it, prepare us emotionally for it, even help legitimate warfare. Cultural work may also help us understand certain social and political issues as inextricable from violent conflict, even when not identified as specific wars. In focusing only on the Haitian Revolution or the American Civil War, for example, we tend to ignore the long histories of struggle against colonialism and slavery that culminated in warfare. In considering only those wars officially recognized by the US government, we forget the military campaigns waged by the US against native peoples in the course of westward expansion. In thinking conventionally about warfare in political and strategic ways, we also tend to ignore the consequences for non-combatants. In historical periods when women participated in warfare primarily in supporting or defensive roles, their experiences of war were often ignored. By the same token, children and the elderly and other non-combatants figure only in the backgrounds of many classic “war novels.”
Henry James produced a large body of work during dramatic changes in Euro-American imperialism. Much of his work deals centrally with characters, situations and settings in which these changes have immediate relevance. As a cosmopolitan author who wrote centrally about the international theme, was born and raised primarily in the United States, lived most of his adult life in Europe, and in 1915 gave up his US citizenship to become a naturalized British subject, James was profoundly influenced by modern transnationalism. Until recently, however, scholars have not devoted central attention to his work in the context of the several imperial nations competing for power between the Civil War and World War I. Of course, many scholars have commented on James’s references to important events in modern imperial history, but most focus on how he incorporated contemporary news into his fiction, rather than on James’s political views of such events.
Throughout the nineteenth century British and US nationalisms often invoked imperial Rome to justify their expansionist ventures. Neoclassical architecture flourished in both nations, especially in the design of state buildings and monuments. Much as the Roman Empire suggested ancient glory and the success of a well-ordered, albeit brutal, state, it was also a reminder of failure. Edward Gibbon’s The History of the Decline and Fall of the Roman Empire (1776–88) was read in Victorian and nineteenth-century US schools, and his account of planning this great, multivolume work during a tour of Italy in 1764, while ‘musing amidst the ruins of the Capitol’, was often imitated by artists and intellectuals wishing to understand the message of ancient Rome’s fall.
Resilience, as defined by Fry and Keyes, the respected editors of this timely volume, “encompasses normal and exceptional development in the face of risk and adversity, recovery, plasticity and regenerative capacity and the ability to maintain function in the face of disability or physical disease.” In short, the capacity to hang tough and bounce back when, inevitably, something bad happens.
Resilience is a hot topic. Interest is reflected by the rapidly growing multidisciplinary literature reviewed in this book's chapters, the attention this topic received in 2009 at the Keck Futures Initiative of the National Academy of Sciences, which was entitled “Future of the Human Healthspan” and in the theme of the 2008 annual meeting of the Gerontological Society of America, “Resilience in an Aging Society: Risks and Opportunities.” In addition, interest in the capacity of individuals to respond to adversity is inevitably spiking as the current economic downturn poses major stress and dislocation for many.