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Background: Inuit children have been observed to have high rates of macrocephaly, which leads to burdensome travel for medical evaluation, often with no pathology identified. Given reports that WHO growth charts may not reflect all populations, we compared head circumference (HC) measurements in a cohort of Inuit children with the WHO charts. Methods: We extracted HC data from a retrospective cohort study where, with Inuit partnership, we reviewed medical records of Inuit children, born between 2010-2013, and residing in Nunavut. We excluded children with preterm birth, documented neurologic/genetic disease, and most congenital anomalies. We compared HC values with the 2007 WHO charts. Results: We analyzed records of 1960 Inuit children (8866 data points). Most data were from ages 0-36 months. At all age points, the cohort had statistically significantly larger HC than WHO medians. At age 12 months, median HC were 1.3 cm and 1.5 cm larger for male and female Inuit children. Using WHO growth curves, macrocephaly was overdiagnosed and microcephaly underdiagnosed. Conclusions: Our results support the observation that Inuit children from Nunavut have larger HCs, and use of the WHO charts may lead to overdiagnosis of macrocephaly and underdiagnosis of microcephaly. Population specific growth curves for Inuit children should be considered.
In Dong et al. (2022, Journal of Operator Theory 88, 365–406), the authors addressed the question of whether surjective maps preserving the norm of a symmetric Kubo-Ando mean can be extended to Jordan $\ast $-isomorphisms. The question was affirmatively answered for surjective maps between the positive definite cones of unital $C^{*}$-algebras for certain specific classes of symmetric Kubo-Ando means. Here, we give a comprehensive answer to this question for surjective maps between the positive definite cones of $AW^{*}$-algebras preserving the norm of any symmetric Kubo-Ando mean.
Early intervention in psychosis (EIP) services improve outcomes for young people, but approximately 30% disengage.
Aims
To test whether a new motivational engagement intervention would prolong engagement and whether it was cost-effective.
Method
We conducted a multicentre, single-blind, parallel-group, cluster randomised controlled trial involving 20 EIP teams at five UK National Health Service (NHS) sites. Teams were randomised using permuted blocks stratified by NHS trust. Participants were all young people (aged 14–35 years) presenting with a first episode of psychosis between May 2019 and July 2020 (N = 1027). We compared the novel Early Youth Engagement (EYE-2) intervention plus standardised EIP (sEIP) with sEIP alone. The primary outcome was time to disengagement over 12–26 months. Economic outcomes were mental health costs, societal costs and socio-occupational outcomes over 12 months. Assessors were masked to treatment allocation for primary disengagement and cost-effectiveness outcomes. Analysis followed intention-to-treat principles. The trial was registered at ISRCTN51629746.
Results
Disengagement was low at 15.9% overall in standardised stand-alone services. The adjusted hazard ratio for EYE-2 + sEIP (n = 652) versus sEIP alone (n = 375) was 1.07 (95% CI 0.76–1.49; P = 0.713). The health economic evaluation indicated lower mental healthcare costs linked to reductions in unplanned mental healthcare with no compromise of clinical outcomes, as well as some evidence for lower societal costs and more days in education, training, employment and stable accommodation in the EYE-2 group.
Conclusions
We found no evidence that EYE-2 increased time to disengagement, but there was some evidence for its cost-effectiveness. This is the largest study to date reporting positive engagement, health and cost outcomes in a total EIP population sample. Limitations included high loss to follow-up for secondary outcomes and low completion of societal and socio-occupational data. COVID-19 affected fidelity and implementation. Future engagement research should target engagement to those in greatest need, including in-patients and those with socio-occupational goals.
People with severe mental illness (SMI) have worse physical health than the general population. There is evidence that support from volunteers can help the mental health of people with SMI, but little evidence regarding the support they can give for physical health.
Aims
To evaluate the feasibility of an intervention where volunteer ‘Health Champions’ support people with SMI in managing their physical health.
Method
A feasibility hybrid randomised controlled trial conducted in mental health teams with people with SMI. Volunteers delivered the Health Champions intervention. We collected data on the feasibility of delivering the intervention, and clinical and cost-effectiveness. Participants were randomised by a statistician independent of the research team, to either having a Health Champion or treatment as usual. Blinding was not done.
Results
We recruited 48 participants: 27 to the intervention group and 21 to the control group. Data were analysed for 34 participants. No changes were found in clinical effectiveness for either group. Implementation outcomes measures showed high acceptability, feasibility and appropriateness, but with low response rates. No adverse events were identified in either group. Interviews with participants found they identified changes they had made to their physical health. The cost of implementing the intervention was £312 per participant.
Conclusions
The Health Champion intervention was feasible to implement, but the implementation of the study measures was problematic. Participants found the intervention acceptable, feasible and appropriate, and it led them to make changes in their physical health. A larger trial is recommended, with tailored implementation outcome measures.
There has been debate about the extent to which the English old poor law could operate as a system of social discipline. This article looks closely at an almost completely neglected set of sources, petitions by local communities asking to stop (or cut) a pauper’s relief, to assess how far poor relief was used as a disciplinary tool. Taking 182 appeals by Lancashire townships from the Civil War to the appearance of workhouses in the county, it suggests that poor relief operated robustly as a system of labour discipline, but only weakly as a wider tool of behavioural control. There is some evidence that townships wanted to end doles to those engaged in ‘bad’ behaviour, such as excessive drinking, gambling, or insubordination, but such cases were infrequent. Far more important were attempts to stop relief where paupers could work or could support themselves through their own productive assets. In turn, townships’ focus on the ability to work suggests that ‘deserving’ poverty was understood in terms of bodily impotence, whilst the need to restrict poor relief to those who were ‘necessitous’ required officers to engage in close surveillance of the poor and their bodies.
With the United States’ entrance into the First World War, linguistic and cultural cohesiveness became imperative, compelling everyone—from immigrants with foreign accents to people with speech problems and hearing loss—to “sound American” by fluently speaking the language of their flag.
This article examines lip-reading, speech, and auricular training prescribed to deaf and hard-of-hearing children as well as for servicemen deafened in the war to demonstrate how World War I demanded all Americans to contribute to and participate in shared national soundscapes, regardless of their hearing status. Use of American Sign Language was considered a conspicuous sign of one’s failure to integrate into hearing society, and it shared parallels with immigrants who failed to learn English and fully assimilate into American culture. Indeed, rehabilitation of deafened soldiers of the First World War through speech training and lip-reading instruction at Hospital No. 11 at Cape May, New Jersey, coincided with broader national efforts to improve Americans’ speech and language use, and in turn, their patriotism and productivity.
In this article, the question of whether the Löwner partial order on the positive cone of an operator algebra is determined by the norm of any arbitrary Kubo–Ando mean is studied. The question was affirmatively answered for certain classes of Kubo–Ando means, yet the general case was left as an open problem. We here give a complete answer to this question, by showing that the norm of every symmetric Kubo–Ando mean is order-determining, i.e., if $A,B\in \mathcal B(H)^{++}$ satisfy $\Vert A\sigma X\Vert \le \Vert B\sigma X\Vert $ for every $X\in \mathcal {A}^{{++}}$, where $\mathcal A$ is the C*-subalgebra generated by $B-A$ and I, then $A\le B$.
Given a set $S=\{x^2+c_1,\dots,x^2+c_s\}$ defined over a field and an infinite sequence $\gamma$ of elements of S, one can associate an arboreal representation to $\gamma$, generalising the case of iterating a single polynomial. We study the probability that a random sequence $\gamma$ produces a “large-image” representation, meaning that infinitely many subquotients in the natural filtration are maximal. We prove that this probability is positive for most sets S defined over $\mathbb{Z}[t]$, and we conjecture a similar positive-probability result for suitable sets over $\mathbb{Q}$. As an application of large-image representations, we prove a density-zero result for the set of prime divisors of some associated quadratic sequences. We also consider the stronger condition of the representation being finite-index, and we classify all S possessing a particular kind of obstruction that generalises the post-critically finite case in single-polynomial iteration.
Studies of early fourth-millennium BC Britain have typically focused on the Early Neolithic sites of Wessex and Orkney; what can the investigation of sites located in areas beyond these core regions add? The authors report on excavations (2011–2019) at Dorstone Hill in Herefordshire, which have revealed a remarkable complex of Early Neolithic monuments: three long barrows constructed on the footprints of three timber buildings that had been deliberately burned, plus a nearby causewayed enclosure. A Bayesian chronological model demonstrates the precocious character of many of the site's elements and strengthens the evidence for the role of tombs and houses/halls in the creation and commemoration of foundational social groups in Neolithic Britain.
Social robots have limited social competences. This leads us to view them as depictions of social agents rather than actual social agents. However, people also have limited social competences. We argue that all social interaction involves the depiction of social roles and that they originate in, and are defined by, their function in accounting for failures of social competence.
‘Governance’ in its simplest form is the way that an organisation is directed and controlled, but the concept of governance also incorporates systems of rules, relationships, and processes to achieve that end. This article focuses on governance of sporting organisations in Australia. Sport in Australia is organised in a singular fashion when compared to other organisations and to sport in other countries. This has significant implications for assumptions about corporate structure, law and governance. The article examines governance of sporting organisations from a number of perspectives and draws distinctions between standard assumptions about governance and the realities of sports governance in Australia. It concludes that a number of assumptions made about organisations in law and governance theory do not apply to Australian sporting organisations. It asks how these anomalies in assumption and execution affect ultimate good governance in sport and impact on the way directors approach their duties.
There is a lack of publicly available information covering the practices insurers employ to manage their exposure to reinsurance recapture risk. A working party was set-up to shed light on the different approaches insurers use to mitigate this complicated to manage risk. This report is intended to form part of a publicly available information repository that market practitioners can refer to and reflect on as best practice evolves and develops.
Over the last fifty years undergraduate research (UR) has transformed from a focus on selected students predominantly engaged in STEM (science, technology, engineering, and mathematics) disciplines at private US universities to one that challenges and transforms undergraduate curricula internationally for all, or many, students. The language used to describe UR varies between institutions, and includes terms such as ‘research-based education’ (Humboldt, Germany), ‘student as producer’ (Lincoln, UK), ‘problem-based and inquiry-based learning’ (McMaster, Canada), and ‘student as scholar’ (Miami, USA).
Evidence for working rock crystal, a rare form of water-clear type of quartz, is occasionally recovered from prehistoric sites in Britain and Ireland, however, very little has been written on the specific methods of working this material, and its potential significance in the past. This paper presents the first synthesis of rock crystal evidence from Britain and Ireland, before examining a new assemblage from the Early Neolithic site of Dorstone Hill, Herefordshire. This outlines a methodology for analysing and interpreting this unusual material, and, through comparison with the flint assemblage, examines the specific uses and treatments of this material. Far from being used to make tools, we argue the distinctive and exotic rock crystal was being used to create distinctive and memorable moments, binding individuals together, forging local identities, and connecting the living and the dead.
Recent years have seen a proliferation of philosophical work on consent. Within this body of work, philosophers often appeal to an account of the interests, values, or functions that underpin the power of consent. By far the most commonly cited value realized by the power of consent is the promotion and protection of the power-holder's autonomy. This focus on autonomy yields what I call the Gate Opener Model of consent, according to which the central valuable function of consent is to give the power-holder control over whether other people can act in certain ways. In this article, I argue that the Gate Opener Model of consent is inadequate. I then defend an alternative Relational Model of consent, according to which a central valuable function of consent is to enable a non-instrumentally valuable form of interaction between people.
The obsidian mirror associated with the Elizabethan polymath and magus John Dee (1527–1608/1609) has been an object of fascination for centuries. The mirror, however, has a deeper history as an Aztec artefact brought to Europe soon after the Spanish conquest. The authors present the results of new geochemical analysis, and explore its history and changing cultural context to provide insights into its meaning during a period in which entirely new world views were emerging. The biography of the mirror demonstrates how a complex cultural history underpins an iconic object. The study highlights the value of new compositional analyses of museum objects for the reinterpretation of historically significant material culture.
Our story is about a civil society initiative activated by local concern over the steady decline of economic and social opportunity in a ‘remote’ rural area in Northumberland. As with many other parts of the Western world, such areas are on the margins of political attention these days, experiencing youth out-migration, ageing populations and difficulties in sustaining needed services (Shucksmith and Brown, 2016). Social renewal in such areas means searching for pathways towards a sustainable future.
The Glendale Gateway Trust (GGT) has grown from the efforts of committed locals, experimenting with how to do things, into an established part of the governance ecosystem in the county of Northumberland. It started in the mid-1990s, centred on creating a community centre and facilities for young people in Wooler, the main centre in Glendale, North Northumberland. It then grew into providing a platform for a range of activities, which have established a community and business hub, generated improvements to the high street, built a locally significant amount of affordable housing, ensured the survival of the local youth hostel, and created a base for a range of other initiatives and programmes. Infused by a sense of the changing wider context, the GGT has developed an entrepreneurial culture, looking out for opportunities and innovating with new ways of doing things. Over time, the GGT has become a significant actor in local development in Northumberland. As a result, it has increasingly been in a position to grasp available opportunities, both economic and political, drawing down investment from the private, public and charitable sectors.
The initiative was motivated not by a particular driving ideology or a specific local crisis, but by locally widespread perceptions of the ebbing away of an old life and the search for practical ways to both renew community vitality and find a sustainable future for the area. On the one hand, the focus has been on remedying what has disappeared or been neglected; on the other, the GGT has tried to open up new opportunities, such as affordable offices for microbusinesses. It can be seen as helping the Glendale area move beyond the sense of a place ‘left behind’ by agricultural change towards alternatives based on what the area can offer in terms of local amenities and assets, notably, the attraction of the landscape, heritage and sense of community for visitors and in-migrants.