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Evidence for necrotising otitis externa (NOE) diagnosis and management is limited, and outcome reporting is heterogeneous. International best practice guidelines were used to develop consensus diagnostic criteria and a core outcome set (COS).
Methods
The study was pre-registered on the Core Outcome Measures in Effectiveness Trials (COMET) database. Systematic literature review identified candidate items. Patient-centred items were identified via a qualitative study. Items and their definitions were refined by multidisciplinary stakeholders in a two-round Delphi exercise and subsequent consensus meeting.
Results
The final COS incorporates 36 items within 12 themes: Signs and symptoms; Pain; Advanced Disease Indicators; Complications; Survival; Antibiotic regimes and side effects; Patient comorbidities; Non-antibiotic treatments; Patient compliance; Duration and cessation of treatment; Relapse and readmission; Multidisciplinary team management.
Consensus diagnostic criteria include 12 items within 6 themes: Signs and symptoms (oedema, otorrhoea, granulation); Pain (otalgia, nocturnal otalgia); Investigations (microbiology [does not have to be positive], histology [malignancy excluded], positive CT and MRI); Persistent symptoms despite local and/or systemic treatment for at least two weeks; At least one risk factor for impaired immune response; Indicators of advanced disease (not obligatory but mut be reported when present at diagnosis). Stakeholders were unanimous that there is no role for secondary, graded, or optional diagnostic items. The consensus meeting identified themes for future research.
Conclusion
The adoption of consensus-defined diagnostic criteria and COS facilitates standardised research reporting and robust data synthesis. Inclusion of patient and professional perspectives ensures best practice stakeholder engagement.
Little is known about the early history of the chicken (Gallus gallus domesticus), including the timing and circumstances of its introduction into new cultural environments. To evaluate its spatio-temporal spread across Eurasia and north-west Africa, the authors radiocarbon dated 23 chicken bones from presumed early contexts. Three-quarters returned dates later than those suggested by stratigraphy, indicating the importance of direct dating. The results indicate that chickens did not arrive in Europe until the first millennium BC. Moreover, a consistent time-lag between the introduction of chickens and their consumption by humans suggests that these animals were initially regarded as exotica and only several centuries later recognised as a source of ‘food’.
Interactions between the sperm-borne oocyte activating factor(s) (SOAF) and the molecules within the oocyte cytoplasm, trigger the molecular pathways associated with oocyte activation. Of note, release of calcium from the endoplasmic reticulum (ER) creates calcium oscillations in mammals and one large calcium release in non-mammalian species. As the newly activated ovum begins to transform, the components of the fertilizing spermatozoon function cooperatively with the contents of the ooplasm as development progresses. The spermatozoon has been shown to contribute the main microtubule framework to the embryo through the integration of its centriole and has also been implicated in facilitating processes. Through oocyte-driven mechanisms, unnecessary sperm components must also be degraded. Many of these processes are centered around the reducing power of oocyte-produced glutathione (GSH) and facilitated by both the sperm-borne and oocyte-borne enzymatic activity. In this chapter we explore underlying molecular and biochemical processes that drive developmental progression of newly fertilized oocytes, and how ICSI procedures could change the molecular pathways found in natural fertilization.
Electroconvulsive therapy (ECT) is recommended in treatment guidelines as an efficacious therapy for treatment-resistant depression. However, it has been associated with loss of autobiographical memory and short-term reduction in new learning.
Aims
To provide clinically useful guidelines to aid clinicians in informing patients regarding the cognitive side-effects of ECT and in monitoring these during a course of ECT, using complex data.
Method
A Committee of clinical and academic experts from Australia and New Zealand met to the discuss the key issues pertaining to ECT and cognitive side-effects. Evidence regarding cognitive side-effects was reviewed, as was the limited evidence regarding how to monitor them. Both issues were supplemented by the clinical experience of the authors.
Results
Meta-analyses suggest that new learning is impaired immediately following ECT but that group mean scores return at least to baseline by 14 days after ECT. Other cognitive functions are generally unaffected. However, the finding of a mean score that is not reduced from baseline cannot be taken to indicate that impairment, particularly of new learning, cannot occur in individuals, particularly those who are at greater risk. Therefore, monitoring is still important. Evidence suggests that ECT does cause deficits in autobiographical memory. The evidence for schedules of testing to monitor cognitive side-effects is currently limited. We therefore make practical recommendations based on clinical experience.
Conclusions
Despite modern ECT techniques, cognitive side-effects remain an important issue, although their nature and degree remains to be clarified fully. In these circumstances it is useful for clinicians to have guidance regarding what to tell patients and how to monitor these side-effects clinically.
The term ‘mood stabiliser’ is ill-defined and lacks clinical utility. We propose a framework to evaluate medications and effectively communicate their mood stabilising properties – their acute and prophylactic efficacy across the domains of mania and depression. The standardised framework provides a common definition to facilitate research and clinical practice.
Declaration of interest
The Treatment Algorithm Group (TAG) was supported logistically by Servier who provided financial assistance with travel and accommodation for those TAG members travelling interstate or overseas to attend the meeting in Sydney (held on 18 November 2017). None of the committee were paid to participate in this project and Servier have not had any input into the content, format or outputs from this project.
This article presents the results of a program of radiocarbon dating and Bayesian modeling from the precontact Yup'ik site of Nunalleq (GDN-248) in subarctic southwestern Alaska. Nunalleq is deeply stratified, presenting a robust relative chronological framework of well-defined individual house floors abundant in ecofacts suitable for radiocarbon dating. Capitalizing on this potential, we present the results of one of the first applications of Bayesian statistical modeling of radiocarbon data from an archaeological site in the North American Arctic. Using these methods, we demonstrate that it is possible to generate robust, high-resolution chronological models from Arctic archaeology. Radiocarbon dates, procured prior to the program of dating and modeling presented here, suggested an approximately three-century duration of occupation at the site. The results of Bayesian modeling nuance this interpretation. While it is possible that there may have been activity for almost three centuries (beginning in the late fourteenth century), occupation of the dwelling complex, which dominates the site, was more likely to have endured for no more than a century. The results presented here suggest that the occupation of Nunalleq likely encompassed three generations beginning cal AD 1570–1630 before being curtailed by conflict around cal AD 1645–1675.
Woody plant encroachment restricts forage production and capacity to produce grazing livestock. Biophysical plant growth simulation and economic simulation were used to evaluate a prescribed burning range management technique. Modeling systems incorporated management practices and costs, historical climate data, vegetation and soil inventories, livestock production data, and historical regional livestock prices. The process compared baseline non-treatment return estimates to expected change in livestock returns resulting from prescribed burning. Stochastic analyses of production and price variability produced estimates of greater net returns resulting from use of prescribed burning relative to the baseline.
Internal isochronous ice sheet layers, recorded by airborne ice-penetrating radar, were measured along an ice flowline across a large (>1 km high) subglacial hill in the foreground of the Transantarctic Mountains. The layers, dated through an existing stratigraphic link with the Vostok ice core, converge with the ice surface as ice flows over the hill without noticeable change to their separation with each other or the ice base. A two-dimensional ice flow model that calculates isochrons and particle flowpaths and accounts for ice flow over the hill under steady-state conditions requires net ablation (via sublimation) over the stoss face for the predicted isochrons to match the measured internal layers. Satellite remote sensing data show no sign of exposed ancient ice at this site, however. Given the lack of exposed glacial ice, surface balance conditions must have changed recently from the net ablation that is predicted at this site for the last 85,000 years to accumulation.
The long-distance transport of the bluestones from south Wales to Stonehenge is one of the most remarkable achievements of Neolithic societies in north-west Europe. Where precisely these stones were quarried, when they were extracted and how they were transported has long been a subject of speculation, experiment and controversy. The discovery of a megalithic bluestone quarry at Craig Rhos-y-felin in 2011 marked a turning point in this research. Subsequent excavations have provided details of the quarrying process along with direct dating evidence for the extraction of bluestone monoliths at this location, demonstrating both Neolithic and Early Bronze Age activity.
This investigation examined the relationship between teachers’ beliefs and their preferences for classroom interventions for behaviours consistent with attention-deficit/hyperactivity disorder (ADHD). Teacher ratings of intervention acceptability, effectiveness, and rate of change were compared across United States and New Zealand samples. Beliefs examined were personal teaching efficacy, general teaching efficacy, and pupil control ideology (PCI). Samples were compared regarding their preferences for the daily report card, response cost technique, classroom lottery, and medication as classroom strategies for managing ADHD-related behavioural concerns. Data were analysed using general linear modelling techniques, and an interaction was demonstrated between ADHD intervention x PCI x nationality. Differences were observed for ADHD interventions across samples based upon pupil control orientations. Implications for educators and their classroom practices are discussed.
Bentley et al.'s scheme generates distributions characteristic of situations of high and low social influence on decisions and of high and low salience (“transparency”) of rewards. Another element of decisions that may influence the placement of a decision process in their map is the way in which individual decisions interact to determine the payoffs. This commentary discusses the role of Nash equilibria in game theory, focusing especially on coordination and anti-coordination games.
Spinoza ([1677] 1996: 68) famously criticized those who, when writing about human affairs, “treat not of natural things, which follow the common laws of Nature, but of things which are outside Nature”. If a naturalist is someone who endorses this criticism, most Anglo-American philosophers are naturalists. Ethics, however, represents something of an anomaly, for here the dominant tone is, if not supernaturalist, then decidedly non-naturalistic. The selfsame considerations which prompt philosophers to be naturalistic realists in their metaphysics seem to urge anti-realism in ethics. The dominant image has us projecting our values onto a disenchanted landscape.
Most of the key figures in the now familiar story of the renaissance of virtue ethics would consider themselves naturalists, and yet their naturalism is very different from that found in metaphysics, epistemology or the philosophy of mind. Aside from debates about character, there is little serious engagement with empirical science. My aim in this chapter is to evaluate the peculiar form of naturalism that is found in virtue ethics rather than in ethical naturalism more broadly. I will argue that while there are good reasons to distance virtue ethics from scientistic naturalism, we should be wary of “conceptual purism”: the idea that philosophy should have no truck with empirical matters. While such a position does insulate virtue ethics from some fairly devastating criticisms emanating from the biological sciences, it concedes too much to scientistic naturalism in its conception of what an engagement with the sciences must look like.