We use cookies to distinguish you from other users and to provide you with a better experience on our websites. Close this message to accept cookies or find out how to manage your cookie settings.
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 no-reply@cambridge.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.
This article discusses how the acclaimed twentieth-century author Rosemary Sutcliff drew upon the archaeological record to advance the didactic aspects of her narratives. Sutcliff was aware that she had a platform to instil certain values in her young readership, and these values were repeatedly exhibited by her protagonists, particularly bravery and fortitude in the face of adversity. In many cases, certain objects are passed down through the generations as a symbol of these values. Usually, these items were drawn either directly from the archaeological record or display close parallels with real-world objects. Subsequently, for the readers of Sutcliff's narratives, the real-world version of the artefact, or a similar item, become encoded with these values and serve to inspire them to emulate her heroes.
Wild oat is a long-standing weed problem in Australian grain cropping systems, potentially reducing the yield and quality of winter grain crops significantly. The effective management of wild oat requires an integrated approach comprising diverse control techniques that suit specific crops and cropping situations. This research aimed to construct and validate a bioeconomic model that enables the simulation and integration of weed control technologies for wild oat in grain production systems. The Avena spp. integrated management (AIM) model was developed with a simple interface to provide outputs of biological and economic data (crop yields, weed control costs, emerged weeds, weed seedbank, gross margins) on wild oat management data in a cropping rotation. Uniquely, AIM was validated against real-world data on wild oat management in a wheat and sorghum cropping rotation, where the model was able to reproduce the patterns of wild oat population changes as influenced by weed control and agronomic practices. Correlation coefficients for 12 comparison scenarios ranged between 0.55 and 0.96. With accurate parameterization, AIM is thus able to make useful predictions of the effectiveness of individual and integrated weed management tactics for wild oat control in grain cropping systems.
Lynchets, often the defining component of historic agricultural landscapes in northern Europe, are generally associated with soft-limestone geologies and are particularly well developed on loess-mantled landscapes. To understand their formation and chronology, the authors present their geoarchaeological analyses of lynchet soils and loess deposits at Blick Mead and Charlton Forest in southern England, and Sint Martens-Voeren in Belgium. The lynchets date from the late prehistoric to the medieval periods and were constructed by plough action at the English sites, and by both cut-and-fill and ploughing in Belgium. This has resulted in the preservation of highly fertile loessic soils across chalk slopes, lost elsewhere. Although each example is associated with local/regional agricultural histories, the lynchets’ effective soil-retention capacities allowed them to survive as important heritage features with environmental benefits over millennia.
Anorexia nervosa (AN) is a serious psychiatric illness that remains difficult to treat. Elucidating the neural mechanisms of AN is necessary to identify novel treatment targets and improve outcomes. A growing body of literature points to a role for dorsal fronto-striatal circuitry in the pathophysiology of AN, with increasing evidence of abnormal task-based fMRI activation within this network among patients with AN. Whether these abnormalities are present at rest and reflect fundamental differences in brain organization is unclear.
Methods
The current study combined resting-state fMRI data from patients with AN (n = 89) and healthy controls (HC; n = 92) across four studies, removing site effects using ComBat harmonization. First, the a priori hypothesis that dorsal fronto-striatal connectivity strength – specifically between the anterior caudate and dlPFC – differed between patients and HC was tested using seed-based functional connectivity analysis with small-volume correction. To assess specificity of effects, exploratory analyses examined anterior caudate whole-brain connectivity, amplitude of low-frequency fluctuations (ALFF), and node centrality.
Results
Compared to HC, patients showed significantly reduced right, but not left, anterior caudate-dlPFC connectivity (p = 0.002) in small-volume corrected analyses. Whole-brain analyses also identified reduced connectivity between the right anterior caudate and left superior frontal and middle frontal gyri (p = 0.028) and increased connectivity between the right anterior caudate and right occipital cortex (p = 0.038). No group differences were found in analyses of anterior caudate ALFF and node centrality.
Conclusions
Decreased coupling of dorsal fronto-striatal regions indicates that circuit-based abnormalities persist at rest and suggests this network may be a potential treatment target.
Telerehabilitation and robotics, either traditional rigid or soft, have been extensively studied and used to improve hand functionality after a stroke. However, a limited number of devices combined these two technologies to such a level of maturity that was possible to use them at the patients’ home, unsupervised. Here we present a novel investigation that demonstrates the feasibility of a system that integrates a soft inflatable robotic glove, a cloud-connected software interface, and a telerehabilitation therapy. Ten chronic moderate-to-severe stroke survivors independently used the system at their home for 4 weeks, following a software-led therapy and being in touch with occupational therapists. Data from the therapy, including automatic assessments by the robot, were available to the occupational therapists in real-time, thanks to the cloud-connected capability of the system. The participants used the system intensively (about five times more movements per session than the standard care) for a total of more than 8 hr of therapy on average. We were able to observe improvements in standard clinical metrics (FMA +3.9 ± 4.0, p < .05, COPM-P + 2.5 ± 1.3, p < .05, COPM-S + 2.6 ± 1.9, p < .05, MAL-AOU +6.6 ± 6.5, p < .05) and range of motion (+88%) at the end of the intervention. Despite being small, these improvements sustained at follow-up, 2 weeks after the end of the therapy. These promising results pave the way toward further investigation for the deployment of combined soft robotic/telerehabilitive systems at-home for autonomous usage for stroke rehabilitation.
Discussions of mithraea tend to emphasize their uniformity. While it is true that many earlier mithraea do adhere to an established plan, there are a notable number of mithraea dating from the late 3rd c. onward that do not. This article discusses these various atypical mithraea, how such alterations to the standard mithraeum plan might have impacted on Mithraic rituals, and how this might have affected the experiences of the participants. It also explores why such changes occurred, observing that while in some instances this may have been to accommodate alterations to ritual practices, in others it was likely due to more mundane issues, such as limitations on space and environmental factors. The article concludes by reflecting on the implications this has for the identification of mithraea in the archaeological record.
Healthcare innovations often represent important improvements in population welfare, but at what cost, and to whom? Health technology assessment (HTA) is a multidisciplinary process to inform resource allocation. HTA is conventionally anchored on health maximization as the only relevant output of health services. If we accept the proposition that health technologies can generate value outside the healthcare system, resource allocation decisions could be suboptimal from a societal perspective. Incorporating “broader value” in HTA as derived from social values and patient experience could provide a richer evaluative space for informing resource allocation decisions. This article considers how HTA is practiced and what its current context implies for adopting “broader value” to evaluating health technologies. Methodological challenges are highlighted, as is a future research agenda. Ireland serves as an example of a healthcare system that both has an explicit role for HTA and is evolving under a current program of reform to offer universal, single-tier access to public services. There are various ways in which HTA processes could move beyond health, including considering the processes of care delivery and/or expanding the evaluative space to some broader concept of well-being. Methods to facilitate the latter exist, but their adaptation to HTA is still emerging. We recommend a multi-stakeholder working group to develop and advance an international agenda for HTA that captures welfare/benefit beyond health.
Terracing is found widely in the Mediterranean and in other hilly and mountainous regions of the world. Yet while archaeological attention to these ‘mundane’ landscape features has grown, they remain understudied, particularly in Northern Europe. Here, the authors present a multidisciplinary study of terraces in the Breamish Valley, Northumberland. The results date their construction to the Early to Middle Bronze Age, when they were built by cutting back the hillside, stone clearance and wall construction. Environmental evidence points to their use for cereal cultivation. The authors suggest that the construction and use of these terraces formed part of an Early to Middle Bronze Age agricultural intensification, which may have been both demographically and culturally driven.
In the past two decades, subanaesthetic doses of ketamine have been demonstrated to have rapid and sustained antidepressant effects, and accumulating research has demonstrated ketamine's therapeutic effects for a range of psychiatric conditions.
Aims
In light of these findings surrounding ketamine's psychotherapeutic potential, we systematically review the extant evidence on ketamine's effects in treating mental health disorders.
Method
The systematic review protocol was registered in PROSPERO (identifier CRD42019130636). Human studies investigating the therapeutic effects of ketamine in the treatment of mental health disorders were included. Because of the extensive research in depression, bipolar disorder and suicidal ideation, only systematic reviews and meta-analyses were included. We searched Medline and PsycINFO on 21 October 2020. Risk-of-bias analysis was assessed with the Cochrane Risk of Bias tools and A Measurement Tool to Assess Systematic Reviews (AMSTAR) Checklist.
Results
We included 83 published reports in the final review: 33 systematic reviews, 29 randomised controlled trials, two randomised trials without placebo, three non-randomised trials with controls, six open-label trials and ten retrospective reviews. The results were presented via narrative synthesis.
Conclusions
Systematic reviews and meta-analyses provide support for robust, rapid and transient antidepressant and anti-suicidal effects of ketamine. Evidence for other indications is less robust, but suggests similarly positive and short-lived effects. The conclusions should be interpreted with caution because of the high risk of bias of included studies. Optimal dosing, modes of administration and the most effective forms of adjunctive psychotherapeutic support should be examined further.
Agitation is a common complication of Alzheimer’s dementia (Agit-AD) associated with substantial morbidity, high healthcare service utilization, and adverse emotional and physical impact on care partners. There are currently no FDA-approved pharmacological treatments for Agit-AD. We present the study design and baseline data for an ongoing multisite, three-week, double-blind, placebo-controlled, randomized clinical trial of dronabinol (synthetic tetrahydrocannabinol [THC]), titrated to a dose of 10 mg daily, in 80 participants to examine the safety and efficacy of dronabinol as an adjunctive treatment for Agit-AD. Preliminary findings for 44 participants enrolled thus far show a predominately female, white sample with advanced cognitive impairment (Mini Mental Status Examination mean 7.8) and agitation (Neuropsychiatric Inventory-Clinician Agitation subscale mean 14.1). Adjustments to study design in light of the COVID-19 pandemic are described. Findings from this study will provide guidance for the clinical utility of dronabinol for Agit-AD. ClinicalTrials.gov Identifier: NCT02792257.
This book offers an analysis and summary of the uses, abuses and limitations of attachment theory in contemporary child welfare practice. Analysing the primary science and drawing on the authors' original empirical work, the book shows how attachment theory can distort and influence decision-making. It argues that the dominant view of attachment theory may promote a problematic diagnostic mindset, whilst undervaluing the enduring relationships between children and adults. The book concludes that attachment theory can still play an important role in child welfare practice, but the balance of the research agenda needs a radical shift towards a sophisticated understanding of the realities of human experience to inform ethical practice.
Developments in threat assessment, particularly in the area of concerning communications and approaches to public figures, has led to the setting-up in a number of countries of a new style of service for assessing and managing risk to the prominent from the actions of lone individuals. Known as fixated threat assessment centres (FTACs), their central characteristic is that they are jointly staffed by police officers and by psychiatric staff from health services. They are based on the realization that the interests of the prominent in terms of protection overlap with those of the people harassing them in terms of medical care. Research over the last decade has re-established that the majority of those threatening, harassing, or attacking public figures have unmet mental health needs, and that attention to these is often the most effective way of reducing risk, whilst at the same time improving their lot and focusing on treatment, rather than criminalization. The approach has recently been expanded to encompass assessment and intervention in individuals suspected of being radicalised into extreme ideologies and at risk of proceeding to commit terrorist acts.
The Late Triassic fauna of the Lossiemouth Sandstone Formation (LSF) from the Elgin area, Scotland, has been pivotal in expanding our understanding of Triassic terrestrial tetrapods. Frustratingly, due to their odd preservation, interpretations of the Elgin Triassic specimens have relied on destructive moulding techniques, which only provide incomplete, and potentially distorted, information. Here, we show that micro-computed tomography (μCT) could revitalise the study of this important assemblage. We describe a long-neglected specimen that was originally identified as a pseudosuchian archosaur, Ornithosuchus woodwardi. μCT scans revealed dozens of bones belonging to at least two taxa: a small-bodied pseudosuchian and a specimen of the procolophonid Leptopleuron lacertinum. The pseudosuchian skeleton possesses a combination of characters that are unique to the clade Erpetosuchidae. As a basis for investigating the phylogenetic relationships of this new specimen, we reviewed the anatomy, taxonomy and systematics of other erpetosuchid specimens from the LSF (all previously referred to Erpetosuchus). Unfortunately, due to the differing representation of the skeleton in the available Erpetosuchus specimens, we cannot determine whether the erpetosuchid specimen we describe here belongs to Erpetosuchus granti (to which we show it is closely related) or if it represents a distinct new taxon. Nevertheless, our results shed light on rarely preserved details of erpetosuchid anatomy. Finally, the unanticipated new information extracted from both previously studied and neglected specimens suggests that fossil remains may be much more widely distributed in the Elgin quarries than previously recognised, and that the richness of the LSF might have been underestimated.
Public and patient involvement (PPI) describes how researchers collaborate and engage with the public in order to make research more relevant to them. The ROLO Family Advisory Committee is a self-selected group of parents who are involved in the longitudinal follow-up of the ROLO Study. It was established in 2017 and the goal is to achieve a partnership between ROLO families and researchers, leading to improved research quality, relevance and outcomes. The aim of engaging with parents from the ROLO study is to understand key outcomes of importance for parents relating to their own health and their children's health and to gain insights into how the research agenda can be more relevant to parent and child needs.
Materials and Methods:
All parents involved with ROLO study were invited to join the ROLO Family Advisory Committee in 2017. Parents who had expressed interest in joining the committee were invited to attend annual ROLO Families Advisory Committee Meetings in 2018 and 2019. Parents were asked to discuss their opinions about current research projects and potential future projects. This was followed by an open discussion about relevant health questions. These meetings were either transcribed on the day or recorded with audio recordings transcribed verbatim and broad themes identified.
Results:
Mothers had greater concern for outcomes relating to their children than themselves. Parents were very interested in understanding the relationship between diet in pregnancy and child health and welcomed research regarding blood tests that could be predictors of future health. Parents had great concern for the effect social media has on child mental health and also wanted more studies conducted in the areas of fussy eating and how to ensure children consume a wide range of healthy foods. It was consistently highlighted that children and teenagers should understand healthy eating principles and ways to promote their physical and mental health.
Discussion:
Through the two focus groups, valuable insights were gained regarding what research parents consider relevant and future research questions. The ROLO agenda has certainly been enriched by PPI. We are seeking opportunities to enable research to be carried out in the areas discussed at the meetings.
Schizophrenia is associated with altered neural development. We assessed neurological soft signs (NSS) and dermatoglyphic anomalies (total a–b ridge count (TABRC) and total finger ridge count) in 15 pairs of twins concordant and discordant for schizophrenia. Within-pair differences in both NSS and TABRC scores were significantly greater in discordant compared to concordant monozygotic pairs. There was no significant difference in NSS and TABRC scores between subjects with schizophrenia and their co-twins without the illness. However, monozygotic discordant twins with schizophrenia had higher ABRCs on their right hands compared to their co-twins without the illness. These findings suggest that an unidentified environmental event acting between weeks 6 and 15 of gestation affects the development of monozygotic twins who go on to develop schizophrenia but does not have a corresponding effect on their co-twins who do not develop the illness. The effect of such an event on dermatoglyphic profiles appears lateralised to the right hand in affected twins.
The rediscovery of the importance of mental illness in the risk assessment and management of those who threaten, approach, and harm public figures has led to a new way of dealing with those that threaten public figures. This approach emphasises the role of “fixation” which may be defined as an intense preoccupation pursued to an abnormally intense degree. It integrates a threat assessment paradigm with the literature on stalking. The need for such an approach was highlighted in research on the prevalence of harassment of public figures. Psychiatry has a key role in this approach which sees mental health clinicians and Police work together in Fixated Threat Assessment Centres (FTACs). An FTAC functions by assessing the level of concern and sharing information to facilitate interventions that are often mental health based. The purpose is not the hopeless task of identifying those who will go on to perpetrate serious violence, rather to intervene in the group they emerge from, to prevent harm. As well as decreasing risk to the persons fixated upon, this approach improves care to the mentally disordered people who harass and threaten them and, in doing so, decreases the likelihood of their criminalization while enhancing their quality of life. As expertise in the area has grown, policing and security agencies in several countries have expanded the FTAC model to cover individuals thought at risk of lone-actor grievance-fueled violence, a term that captures both different forms of mass killing and lone actor terrorism.
It is no hyperbole to describe Glasgow as a Sick City within a Sick Country. Across an almost exhaustive set of mortality and morbidity indicators, Glasgow and Scotland perform badly in relation to otherwise comparable places. This chapter has two substantive aims. First, it draws on an extensive and pioneering body of research led by the Glasgow Centre for Population Health (GCPH) to paint a detailed picture of health across Scotland and Glasgow over time. Second, drawing on Scottish, UK and international literature, it presents a summary of explanations as to why Glasgow finds itself with its current health profile. Our argument is not to say that Glasgow's health profile has a different set of causes from those driving health and inequalities in cities across the world but that, in the context of post-industrial cities at least, these causes have aligned in particularly detrimental ways and have been insufficiently mitigated. The chapter should be read within the context of a wealth of international research that recognises that enduring socio-economic inequalities in health may have proximal causes relating to health-related behaviours, but that these can only be properly understood within a ‘fundamental causes’ framework which sees a range of political processes and their ensuing material and psychosocial realities as the drivers of health inequalities (McCartney et al, 2013).
Scotland, Glasgow and west central Scotland: contemporary health profiles in context
The comparatively poor contemporary health profiles of Scotland and, in particular, Glasgow and its post-industrial conurbation of West Central Scotland (WCS) have become widely known. Moving far beyond, and countering, stereotypical portrayals of poor health as being innate to Scots and Glaswegians, the extensive body of work of the Glasgow Centre for Population Health (GCPH) offers a detailed understanding of the health profiles of these populations as they have been shaped over time. This body of work is comprised mainly of epidemiological research, involving analyses of statistical data available at a population-wide level to map inequalities in health outcomes across and between different population groups over time. These health outcomes are primarily measured by life expectancy – the average number of years someone from a defined population can be expected to live for – and by mortality and morbidity rates; respectively, the frequency of deaths, or of an incidence of a specific disease or medical condition, across a given population over a given period of time (typically per year).