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Despite evidence of gender differences in bipolar disorder characteristics and comorbidity, there is little research on the differences in treatment and service use between men and women with bipolar disorder.
To use routine data to describe specialist mental health service contact for bipolar disorder, including in-patient, community and support service contacts; to compare clinical characteristics and mental health service use between men and women in contact with secondary services for bipolar disorder.
Cross-sectional analysis of mental health patients with bipolar disorder in New Zealand, based on complete national routine health data.
A total of 3639 individuals were in contact with specialist mental health services with a current diagnosis of bipolar disorder in 2015. Of these 58% were women and 46% were aged 45 and over. The 1-year prevalence rate of bipolar disorder leading to contact with specialist mental health services was 1.56 (95% CI 1.50–1.63) per 100 000 women and 1.20 (95% CI 1.14–1.26) per 100 000 men. Rates of bipolar disorder leading to service contact were 30% higher in women than men (rate ratio 1.30, 95% CI 1.22–1.39). The majority (68%) had a diagnosis of bipolar I disorder. Women were more likely to receive only out-patient treatment and have comorbid anxiety whereas more men had substance use disorder, were convicted for crimes when unwell, received compulsory treatment orders and received in-patient treatment.
Although the prevalence of bipolar disorder is equal between men and women in the population, women were more likely to have contact with specialist services for bipolar disorder but had a lower intensity of service interaction.
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.
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.
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.
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.
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.
In this article Roger Porter analyzes five plays about Oscar Wilde, by Leslie and Sewell Stokes, David Hare, Eric Bentley, Moises Kaufman, and Terry Eagleton. He focuses on various aspects of the three Wilde trials of 1895, and shows how, while the plays employ verbatim transcripts of the court records, they use the latter in quite different ways and with different emphases, suggesting how the several playwrights regard Douglas in his relation with Wilde, as well as Douglas's implication in the verdict. Several of the plays focus almost exclusively on Wilde's personality, while others engage with larger issues, including Victorian moral regulation of sexuality, the relation of art to society, and English attitudes towards the Irish. He also stresses how the plays’ dramaturgy relates to their perspectives on Wilde, especially on his cultural role. Roger Porter is Professor Emeritus of English, Reed College, Portland, Oregon, USA. He is the author of Self-Same Songs: Autobiographical Performances and Reflections (University of Nebraska Press), Bureau of Missing Persons: Writing the Secret Lives of Fathers (Cornell University Press), and co-editor (with Sandra Gilbert) of Eating Words: a Norton Anthology of Food Writing.
Transient Ischaemic Attack (TIA) is a neurologic event with symptom resolution within 24 hours. Early specialist assessment of TIA reduces risk of stroke and death. National United Kingdom (UK) guidelines recommend patients with TIA are seen in specialist clinics within 24 hours (high risk) or seven days (low risk).
We aimed to develop a complex intervention for patients with low risk TIA presenting to the emergency ambulance service. The intervention is being tested in the TIER feasibility trial, in line with Medical Research Council (MRC) guidance on staged development and evaluation of complex interventions.
We conducted three interrelated activities to produce the TIER intervention:
• Survey of UK Ambulance Services (n = 13) to gather information about TIA pathways already in use
• Scoping review of literature describing prehospital care of patients with TIA
• Synthesis of data and definition of intervention by specialist panel of: paramedics; Emergency Department (ED) and stroke consultants; service users; ambulance service managers.
The panel used results to define the TIER intervention, to include:
1. Protocol for paramedics to assess patients presenting with TIA and identify and refer low risk patients for prompt (< 7day) specialist review at TIA clinic
2. Patient Group Directive and information pack to allow paramedic administration of aspirin to patients left at home with referral to TIA clinic
3. Referral process via ambulance control room
4. Training package for paramedics
5. Agreement with TIA clinic service provider including rapid review of referred patients
We followed MRC guidance to develop a clinical intervention for assessment and referral of low risk TIA patients attended by emergency ambulance paramedic. We are testing feasibility of implementing and evaluating this intervention in the TIER feasibility trial which may lead to fully powered multicentre randomized controlled trial (RCT) if predefined progression criteria are met.
Background. Although diurnal variation of mood is a widely recognized symptom of depression, the clinical, neurobiological and psychopharmacological significance of this symptom has not previously been reported.
Method. A total of 195 depressed out-patients underwent a detailed clinical and neurobiological assessment, and were then randomized to treatment with either fluoxetine or nortriptyline.
Results. Of the 195 depressed patients, 62 had a pattern of reversed diurnal variation (i.e. worse in the evening). Those with reversed diurnal variation had a poorer response to a serotonergic antidepressant, were less likely to have bipolar II disorder, had a higher tryptophan:large neutral amino acid ratio and had different allele frequencies of the polymorphisms in the promoter region of the serotonin transporter.
Conclusions. These findings raise the possibility of serotonergic influence on diurnal variation, and that the symptom of reversed diurnal variation is of relevance to antidepressant prescribing.
The ctenostome bryozoan Alcyonidium diaphanum is widespread and abundant in the coastal waters of England and Wales. It was recorded in 77–90% of beam trawl catches in the eastern English Channel and southern North Sea, and in 53–73% of catches in the Bristol Channel and Irish Sea. The maximum catch rates in these two study areas were 1410 and 751 kg h−1 respectively. Alcyonidium diaphanum was most abundant in the greater Thames Estuary. Additional data from the North Sea indicated that A. diaphanum is widely distributed throughout the southern North Sea. Alcyonidium diaphanum was found intertidally in only seven of 99 locations sampled. Several different morphotypes were observed, ranging from cylindrical to lobate forms. The distribution patterns of various morphotypes are discussed.
Thermal Mechanical analysis (TMA) has been used to study the crystallization
behavior of poly (ether ether ketone) (PEEK) and its blends with poly (ether
imide) (PEI). The two crystallization stages of PEEK are clearly
distinguished by measuring the variation of film thickness with time during
isothermal crystallization. Upon blending with PEI, the distinction of the
two PEEK crystallization stages becomes obscure. This is attributed to the
depressions in both nucleation density and spherulite growth rate upon
blending with PEI.
An Avrami analysis, Modified by considering both primary and secondary
crystallization, is used to extract the respective kinetic behavior of these
two crystallization stages. The results indicate that the secondary
crystallization proceeded slower than the primary crystallization in the
diffusion-controlled crystallization region. On the other hand, these two
crystallization stages proceeded at comparable rate in the
thermodynamically-controlled crystallization region. It is also found in the
diffusion-controlled crystallization that blending with PEI induced a larger
depression in the secondary crystallization rate than in the primary
crystallization rate. Explanations for these observations are proposed and
An Organically-modified silicate (Ormosil) which contains 28 wt% polydimethylsiloxane and 72 wt% silica has been used as a matrix to fabricate CdS-doped glassy nanocomposites by using the sol-gel method. Samples were prepared both in bulk and film forms. High semiconductor concentrations, up to 20 wt% CdS could be obtained and the semiconductor microcrystallites were formed at temperatures much lower than that of the purely inorganic glass matrix. Preparation methods of these CdS-doped Ormosils are described. Optical behaviors of these nanocomposites under normal and intense photon influx were studied.
On 27 June 1990, President Bush launched the Enterprise for the Americas Initiative as a part of his longstanding interest in encouraging democracy and economic growth in Latin America and the Caribbean. Impressed by political and economic events in Latin America, he felt a new approach was needed to help advance prosperity throughout the region.
Recent events in the Western Hemisphere are part of a worldwide phenomenon. The past 18 months have witnessed enormous economic and political change.
These changes are almost universally positive and, not least, are being achieved peacefully. Indicative of these changes is the assertion by Charles William Maynes that in the future “economists will be more important than geopoliticians [and] diplomats more critical than warriors” (Maynes, 1990). There is a fresh, dynamic attitude around the world that views change optimistically, not fearfully.