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: Carbapenem-resistant Acinetobacter baumannii (CRAB) has emerged as a major cause of bloodstream infection among hospitalized patients in low- and middle-income countries (LMICs). CRAB infections can be difficult to treat and are devastating in neonates (~30% mortality). CRAB outbreaks are hypothesized to arise from reservoirs in the hospital environment, but outbreak investigations in LMICs seldom incorporate whole-genome sequencing (WGS). Methods: WGS (Illumina NextSeq) was performed at the National Institute for Communicable Diseases (South Africa) on 43 preserved A. baumannii isolates from a 530-bed referral hospital in Gaborone, Botswana, from March 2021–August 2022. This included 23 blood-culture isolates from 21 unique patients (aged 2 days–69 years) and 20 environmental isolates collected at the 36-bed neonatal unit in April–June 2021. Infections were considered healthcare-associated if the culture was obtained >72 hours after hospital arrival (or sooner in inborn infants). Blood cultures were incubated using an automated system (BACT/ALERT, BioMérieux) and were identified using manual methods. Environmental isolates were identified using selective or differential chromogenic media (CHROMagarTM). Taxonomic assignment, multilocus sequence typing (MLST), antimicrobial resistance gene identification, and phylogenetic analyses were performed using publicly accessible analysis pipelines. Single-nucleotide polymorphism (SNP) matrices were used to assess clonal lineage. Results: All 23 blood isolates and 5 (25%) of 20 environmental isolates were confirmed as A. baumannii; thus, 28 A. baumannii isolates were included in the phylogenetic analysis. MLST revealed that 22 (79%) of 28 isolates were sequence type 1 (ST1), including all 19 healthcare-associated blood isolates and 3 (60%) of 5 environmental isolates. Genes encoding for carbapenemases (blaNDM-1, blaOXA-23) and biocide resistance (qacE) were present in all 22 ST1 isolates; colistin resistance genes were not identified. Phylogenetic analysis of the ST1 clade demonstrated spatial clustering by hospital unit. Related isolates spanned wide ranges in time (>1 year), suggesting ongoing transmission from environmental sources (Fig. 1). An exclusively neonatal clade (0–2 SNPs) containing all 8 neonatal blood isolates was closely associated with 3 environmental isolates from the neonatal unit: a sink drain, bed rail, and a healthcare worker’s hand. Conclusions: WGS analysis of clinical and environmental A. baumannii revealed the presence of unit-specific CRAB clones, with evidence of ongoing transmission likely driven by persistent environmental reservoirs. This research highlights the potential of WGS to detect hospital outbreaks and reaffirms the importance of environmental sampling to identify and remediate reservoirs (eg, sinks) and vehicles (eg, hands and equipment) within the healthcare environment.
The Expression of the Emotions in Man and Animals has been considered Charles Darwin's forgotten masterpiece and is his only book on psychology. It is also the first ever systematic application of Darwinian theory to the expression of emotions and has been considered by some to be the foundational text of evolutionary psychology. This article explores some key concepts in the book and gives reasons why both psychiatry and psychology can benefit greatly from becoming better acquainted with this work.
The Chanyuan Covenant of 1005 that ended decades of war between Song and Liao precipitated a new political model that, from the Song perspective, exchanged wealth, territory, and dynastic pride in return for peace along the northern frontier, civilian sovereignty over a long-dominant military class, and the replacement of a culture of arms with the love of books. That “Chanyuan Paradigm” survived the Qingli war of 1040–1044 with the Tangut Xi Xia, but was steadily overturned in the expansionist wars promoted by Shenzong and his sons from 1068 through the fall of the Northern Song in 1127. This article argues that the fragility of the Chanyuan-style peace did not stem from the aspirations of a revanchist emperor and his confidantes, but was rather the consequence of the intrinsic difficulties of maintaining peace in a world of new players, internecine political contests, and shifting geopolitical alliances that characterized the mid-eleventh century.
The U.S. Department of Agriculture–Agricultural Research Service (USDA-ARS) has been a leader in weed science research covering topics ranging from the development and use of integrated weed management (IWM) tactics to basic mechanistic studies, including biotic resistance of desirable plant communities and herbicide resistance. ARS weed scientists have worked in agricultural and natural ecosystems, including agronomic and horticultural crops, pastures, forests, wild lands, aquatic habitats, wetlands, and riparian areas. Through strong partnerships with academia, state agencies, private industry, and numerous federal programs, ARS weed scientists have made contributions to discoveries in the newest fields of robotics and genetics, as well as the traditional and fundamental subjects of weed–crop competition and physiology and integration of weed control tactics and practices. Weed science at ARS is often overshadowed by other research topics; thus, few are aware of the long history of ARS weed science and its important contributions. This review is the result of a symposium held at the Weed Science Society of America’s 62nd Annual Meeting in 2022 that included 10 separate presentations in a virtual Weed Science Webinar Series. The overarching themes of management tactics (IWM, biological control, and automation), basic mechanisms (competition, invasive plant genetics, and herbicide resistance), and ecosystem impacts (invasive plant spread, climate change, conservation, and restoration) represent core ARS weed science research that is dynamic and efficacious and has been a significant component of the agency’s national and international efforts. This review highlights current studies and future directions that exemplify the science and collaborative relationships both within and outside ARS. Given the constraints of weeds and invasive plants on all aspects of food, feed, and fiber systems, there is an acknowledged need to face new challenges, including agriculture and natural resources sustainability, economic resilience and reliability, and societal health and well-being.
We report electroencephalography (EEG) results from a non-patient pilot study conducted whilst developing a neuromodulation approach for improving visual spatial working memory (vSWM) in people with schizophrenia. Working memory impairments are common in people with schizophrenia yet respond poorly to current drug treatments. Transcranial magnetic stimulation (TMS), a minimally-invasive, well-tolerated, brain stimulation technique that is performed whilst a person is awake and alert, may improve working memory performance. However, results have been inconsistent, possibly because TMS was delivered during the heterogenous “resting-state”. We delivered TMS to left dorsolateral prefrontal cortex time-locked to specific events in a vSWM task, aiming to modulate functional networks involved in encoding spatial data into working memory.
Each trial in the vSWM task started with a 2-second-long sample display containing either three or four coloured circles positioned at random locations. This was followed by a 2-second delay period. At the end of the delay period, a visual cue appeared, indicating the target colour. Participants moved a crosshair to the screen location where the target had appeared. We recorded 64-channel EEG throughout. In Experiment 1, twelve participants completed three- and four-item task versions. In Experiment 2, eighteen participants completed the four-item task in three separate blocks within a single session. Between blocks, they completed a short task version alongside TMS. TMS (intermittent theta burst stimulation, 600 pulses, 3.3 minutes) was delivered over the F3 electrode position. Each stimulation on-phase was synchronised to coincide with the onset of sample display. In a random order, one TMS block was active, and one was sham (90° coil rotation).
In Experiment 1, EEG showed decreases (“desynchronisation”) in beta (13–30 Hz) power during sample display and increases (“synchronisation”) during the delay period. Both effects were greater in the four-item condition, and in posterior electrodes. In Experiment 2, posterior beta desynchronisation during sample display was greater following either active or sham stimulation. However, synchronisation during the delay period reduced following sham and increased only following active stimulation. Likewise, performance declined following sham but remained stable or improved following active stimulation.
We examined the effects of TMS on electrophysiological signals evoked during a spatial working memory task. We found that beta-band oscillatory activity, thought to safeguard stored information during memory delays, was increased by memory load and maintained or restored in blocks following active TMS. These effects were greatest over parietal/occipital areas. It is suggested that this beta activity serves to protect memory traces from distractors (in the current case, internal distractors). Notably, if TMS enhances delay activity within areas of the brain involved in stimulus representation that are distal from the stimulation site, then its effects are best understood as network level modulations of brain activity.
Admission to a Psychiatric inpatient unit can be a stressful time for patients and families. Patient's and carers have advised staff on the ward that there is a lack of information available regarding the policies and procedures in the unit. This includes information on ward rounds, leave arrangements and discharge planning. The aim is to enhance the ward-based experience of patients and their families by attempting to explore areas to improved, particularly about providing information that will help them to understand the process of admission to an inpatient Psychiatric as well as what to expect throughout their admission and on discharge.
A questionnaire was distributed to all the ‘current’ in-patients and their families. The questionnaire was kept anonymous to encourage everyone to contribute honestly. Data were collected from 20 patients admitted to the ward from 01.02.2022 to 30.04.2022. Data were analysed and shared with the rest of the team to identify gaps in provision of information.
Half of patients reported not receiving an introduction to the ward on admission and being unaware of the roles of different staff members. 70% of the patients and relatives were aware of the facilities of the ward and how to use them. There was a mixed response about satisfaction with running of Multidisciplinary Team Meetings(MDTs), availability of name nurse and medical team and information provision around MDTs, leave arrangement, discharge planning and follow up.
This quality improvement project has highlighted inconsistencies in the quality of and satisfaction with information provision during admission and has helped to recognised areas that needed to be improved. Several steps have been taken to improve quality of care such as copies of care plan and "Welcome to Tissington" booklet have provided. Discharge pathways and name board displayed in reception. Ward round appointments given to patients in advance and named nurse to support patients in writing MDT meeting plan. Invite families to attend care plan reviews, ward rounds and discharge meeting in person/via online. Additional craft items made available for activity, and exercise and walking groups have been introduced. Additional time made available for carers to speak with ward staff. Recruitment of Psychologist and occupational therapists now in post and Carers meeting to commence.
It is important to repeat this quality improvement project regularly to monitor the progress and get more information from families and patients to improve the quality of care given by the ward.
There is growing interest in music-based therapies for mental/behavioural disorders. We begin by reviewing the evolutionary and cultural origins of music, proceeding then to discuss the principles of evolutionary psychiatry, itself a growing a field, and how it may apply to music. Finally we offer some implications for the role of music and music-based therapies in clinical practice.
What are the opportunities and challenges of faculty–undergraduate collaborative scholarship that involves student participation at every stage of the research process? Drawing on interviews with comparative politics faculty members and undergraduate students, this article discusses the themes of reciprocity, incentives, and “off-ramps.” First, we find that an unequal division of labor can give way to a more reciprocal work dynamic as long-term projects unfold. Second, we consider the use of incremental incentives to sustain student motivation. Third, we propose the creation of off-ramps to allow an undergraduate to gracefully exit a project early. Grounded in these themes, we argue that—with a few guardrails—faculty members and undergraduate students can benefit from long-term collaborative research projects, including those that involve fieldwork or that seek to publish peer-reviewed articles.
Distributed Acoustic Sensing (DAS) is increasingly recognised as a valuable tool for glaciological seismic applications, although analysing the large data volumes generated in acquisitions poses computational challenges. We show the potential of active-source DAS to image and characterise subglacial sediment beneath a fast-flowing Greenlandic outlet glacier, estimating the thickness of sediment layers to be 20–30 m. However, the lack of subglacial velocity constraint limits the accuracy of this estimate. Constraint could be provided by analysing cryoseismic events in a counterpart 3-day record of passive seismicity through, for example, seismic tomography, but locating them within the 9 TB data volume is computationally inefficient. We describe experiments with data compression using the frequency-wavenumber (f-k) transform ahead of training a convolutional neural network, that provides a ~300-fold improvement in efficiency. In combining active and passive-source and our machine learning framework, the potential of large DAS datasets could be unlocked for a range of future applications.
This paper proposes a framework for comprehensive, collaborative, and community-based care (C4) for accessible mental health services in low-resource settings. Because mental health conditions have many causes, this framework includes social, public health, wellness and clinical services. It accommodates integration of stand-alone mental health programs with health and non-health community-based services. It addresses gaps in previous models including lack of community-based psychotherapeutic and social services, difficulty in addressing comorbidity of mental and physical conditions, and how workers interact with respect to referral and coordination of care. The framework is based on task-shifting of services to non-specialized workers. While the framework draws on the World Health Organization’s Mental Health Gap Action Program and other global mental health models, there are important differences. The C4 Framework delineates types of workers based on their skills. Separate workers focus on: basic psychoeducation and information sharing; community-level, evidence-based psychotherapeutic counseling; and primary medical care and more advanced, specialized mental health services for more severe or complex cases. This paper is intended for individuals, organizations and governments interested in implementing mental health services. The primary aim is to provide a framework for the provision of widely accessible mental health care and services.
When judging their likelihood of success in competitive tasks, people tend to be overoptimistic for easy tasks and overpessimistic for hard tasks (the shared circumstance effect; SCE). Previous research has shown that feedback and experience from repeated-play competitions has a limited impact on SCEs. However, in this paper, we suggest that competitive situations, in which the shared difficulty or easiness of the task is more transparent, will be more amenable to debiasing via repeated play. Pairs of participants competed in, made predictions about, and received feedback on, multiple rounds of a throwing task involving both easy- and hard-to-aim objects. Participants initially showed robust SCEs, but they also showed a significant reduction in bias after only one round of feedback. These and other results support a more positive view (than suggested from past research) on the potential for SCEs to be debiased through outcome feedback.
People must often perform calculations in order to produce a numeric estimate (e.g., a grocery-store shopper estimating the total price of his or her shopping cart contents). The current studies were designed to test whether estimates based on calculations are influenced by comparisons with irrelevant anchors. Previous research has demonstrated that estimates across a wide range of contexts assimilate toward anchors, but none has examined estimates based on calculations. In two studies, we had participants compare the answers to math problems with anchors. In both studies, participants’ estimates assimilated toward the anchor values. This effect was moderated by time limit such that the anchoring effects were larger when the participants’ ability to engage in calculations was limited by a restrictive time limit.
People often use tools for tasks, and sometimes there is uncertainty about whether a given task can be completed with a given tool. This project explored whether, when, and how people’s optimism about successfully completing a task with a given tool is affected by the contextual salience of a better or worse tool. In six studies, participants were faced with novel tasks. For each task, they were assigned a tool but also exposed to a comparison tool that was better or worse in utility (or sometimes similar in utility). In some studies, the tool comparisons were essentially social comparisons, because the tool was assigned to another person. In other studies, the tool comparisons were merely counterfactual rather than social. The studies revealed contrast effects on optimism, and the effect worked in both directions. That is, worse comparison tools boosted optimism and better tools depressed optimism. The contrast effects were observed regardless of the general type of comparison (e.g., social, counterfactual). The comparisons also influenced discrete decisions about which task to attempt (for a prize), which is an important finding for ruling out superficial scaling explanations for the contrast effects. It appears that people fail to exclude irrelevant tool-comparison information from consideration when assessing their likelihood of success on a task, resulting in biased optimism and decisions.
If human population growth is not controlled, natural areas must be sacrificed. An alternative is to create more habitat, terraforming Mars. However, this requires establishment of essential, ecosystem services on a planet currently unamenable to Terran species. Shorter term, assembling Terran-type ecosystems within contained environments is conceivable if mutually supportive species complements are determined. Accepting this, an assemblage of organisms that might form an early, forest environment is proposed, with rationale for its selection. A case is made for developing a contained facsimile, old growth forest on Mars, providing an oasis, proffering vital ecosystem functions (a forest bubble). It would serve as an extraterrestrial nature reserve (ETNR), psychological refuge and utilitarian botanic garden, supporting species of value to colonists for secondary metabolites (vitamins, flavours, perfumes, medicines, colours and mood enhancers). The design presented includes organisms that might tolerate local environmental variance and be assembled into a novel, bioregenerative forest ecosystem. This would differ from Earthly forests due to potential impact of local abiotic parameters on ecosystem functions, but it is argued that biotic support for space travel and colonization requires such developments. Consideration of the necessary species complement of an ETNR supports a view that it is not humanity alone that is reaching out to space, it is life, with all its diverse capabilities for colonization and establishment. Humans cannot, and will not, explore space alone because they did not evolve in isolation, being shaped over aeons by other species. Space will be travelled by a mutually supportive system of Terran organisms amongst which humans fit, exchanging metabolites and products of photosynthesis as they have always done.
This introductory chapter serves multiple purposes. Its primary aim is to introduce psychiatrists and other mental health professionals who are new to Darwinian thinking to some of the basic concepts and terminology of evolutionary science in order to ease their progress through the remaining chapters of this volume. Another aim is to provide a distillation and update of some significant theoretical and other developments in a variety of evolutionary disciplines relevant to psychiatry and psychology that would be of benefit to all readers, including existing evolutionists. Given the constraints of space, there will inevitably be significant omissions. We have elected to cover the basics of standard evolutionary theory, as well as some of the basic principles of evolutionary psychology and medicine. We also briefly survey some of the recent developments in the evolutionary literature on cultural evolution and related fields. We recognise that a balance needs to be struck between covering as wide an area as possible without the chapter becoming a glossary of terms. Readers unfamiliar with specialised evolutionary terms are advised to consult the glossary on the Evolutionary Psychiatry Special Interest Group at the Royal College of Psychiatrists’ website: www.epsig.org (click on ‘About us’ then ‘Resources’).