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.
In most ancient cultures, what we now call religion was interwoven throughout all aspects of life and did not always form a discrete cultural domain. Nevertheless, its principal symbols and traditions can be sufficiently distinguished to allow for a fruitful examination of the relationship of law and religion in antiquity. This chapter pursues that endeavour, with particular attention to instances when the sources at our disposal indicate, explicitly or implicitly, that law was relying on religious ideas to achieve legal ends. The chapter considers the role of religion in legitimizing law, in public law and governance, in legal transactions and proceedings, and in the determination and punishment of wrongdoing. It ultimately seeks to add clarity and specificity to the scholarly description of how law and religion interacted in the ancient world.
The current coronavirus disease (COVID-19) pandemic has placed unprecedented strain on underfunded public health resources in the Southeastern United States. The Memphis, TN, metropolitan region has lacked infrastructure for health data exchange.
This manuscript describes a multidisciplinary initiative to create a community-focused COVID-19 data registry, the Memphis Pandemic Health Informatics System (MEMPHI-SYS). MEMPHI-SYS leverages test result data updated directly from community-based testing sites, as well as a full complement of public health data sets and knowledge-based informatics. It has been guided by relationships with community stakeholders and is managed alongside the largest publicly funded community-based COVID-19 testing response in the Mid-South. MEMPHI-SYS has supported interactive Web-based analytic resources and informs federally funded COVID-19 outreach directed toward neighborhoods most in need of pandemic support.
MEMPHI-SYS provides an instructive case study of how to collaboratively establish the technical scaffolding and human relationships necessary for data-driven, health equity-focused pandemic surveillance, and policy interventions.
Quizzes are a ubiquitous part of the dementia social care landscape. This article explores why. Using an ethnographic approach which draws on close analysis of communication, we examine dementia quizzes as a ‘social practice’, and what such a lens can tell us about their popularity in social care settings. Vignettes of real interactions drawn from ten different quizzes recorded in four different group settings attended by 28 people living with dementia and 15 staff members are presented to highlight particular issues. We show that the conditions of post-diagnosis dementia social care are uniquely well suited to an activity such as quizzes which are malleable, requiring little preparation or materials, and impose a communication framework which can help to organise the interactional space. Quizzes also draw on previously forged interactional competences, such as turn-taking and question–answer sequences, a skill that has been shown to persist even as dementia progresses. Finally, we argue that the meaning of quizzes with people with dementia feeds into wider societal values and associations attached to memory, dementia and personhood. The extent to which quizzes are akin to a ‘test’ or a fun and enjoyable social activity rests in how they are enacted. We suggest that practice can be adapted, developed and made more inclusive through input from people living with dementia themselves.
Research among non-industrial societies suggests that body kinematics adopted during running vary between groups according to the cultural importance of running. Among groups in which running is common and an important part of cultural identity, runners tend to adopt what exercise scientists and coaches consider to be good technique for avoiding injury and maximising performance. In contrast, among groups in which running is not particularly culturally important, people tend to adopt suboptimal technique. This paper begins by describing key elements of good running technique, including landing with a forefoot or midfoot strike pattern and leg oriented roughly vertically. Next, we review evidence from non-industrial societies that cultural attitudes about running associate with variation in running techniques. Then, we present new data from Tsimane forager–horticulturalists in Bolivia. Our findings suggest that running is neither a common activity among the Tsimane nor is it considered an important part of cultural identity. We also demonstrate that when Tsimane do run, they tend to use suboptimal technique, specifically landing with a rearfoot strike pattern and leg protracted ahead of the knee (called overstriding). Finally, we discuss processes by which culture might influence variation in running techniques among non-industrial societies, including self-optimisation and social learning.
To improve maternal health outcomes, increased diversity is needed among pregnant people in research studies and community surveillance. To expand the pool, we sought to develop a network encompassing academic and community obstetrics clinics. Typical challenges in developing a network include site identification, contracting, onboarding sites, staff engagement, participant recruitment, funding, and institutional review board approvals. While not insurmountable, these challenges became magnified as we built a research network during a global pandemic. Our objective is to describe the framework utilized to resolve pandemic-related issues.
Methods:
We developed a framework for site-specific adaptation of the generalized study protocol. Twice monthly video meetings were held between the lead academic sites to identify local challenges and to generate ideas for solutions. We identified site and participant recruitment challenges and then implemented solutions tailored to the local workflow. These solutions included the use of an electronic consent and videoconferences with local clinic leadership and staff. The processes for network development and maintenance changed to address issues related to the COVID-19 pandemic. However, aspects of the sample processing/storage and data collection elements were held constant between sites.
Results:
Adapting our consenting approach enabled maintaining study enrollment during the pandemic. The pandemic amplified issues related to contracting, onboarding, and IRB approval. Maintaining continuity in sample management and clinical data collection allowed for pooling of information between sites.
Conclusions:
Adaptability is key to maintaining network sites. Rapidly changing guidelines for beginning and continuing research during the pandemic required frequent intra- and inter-institutional communication to navigate.
Early in the coronavirus disease 2019 (COVID-19) pandemic, the CDC recommended collection of a lower respiratory tract (LRT) specimen for severe acute respiratory coronavirus virus 2 (SARS-CoV-2) testing in addition to the routinely recommended upper respiratory tract (URT) testing in mechanically ventilated patients. Significant operational challenges were noted at our institution using this approach. In this report, we describe our experience with routine collection of paired URT and LRT sample testing. Our results revealed a high concordance between the 2 sources, and that all children tested for SARS-CoV-2 were appropriately diagnosed with URT testing alone. There was no added benefit to LRT testing. Based on these findings, our institutional approach was therefore adjusted to sample the URT alone for most patients, with LRT sampling reserved for patients with ongoing clinical suspicion for SARS-CoV-2 after a negative URT test.
Ecosystems across the globe are vulnerable to the effects of climate change, as are the communities that depend on them. However, ecosystems can also protect people from climate change impacts. As the evidence base strengthens, nature-based solutions (NbS) are increasingly prominent in climate change policy, especially in developing nations. Yet intentions rarely translate into measurable, evidence-based targets. As Paris Agreement signatories revise their Nationally Determined Contributions, we argue that NbS are key to meeting global goals for climate and biodiversity, and we urge researchers to work more closely with policy-makers to identify targets that benefit both people and ecosystems.
Many institutions are attempting to implement patient-reported outcome (PRO) measures. Because PROs often change clinical workflows significantly for patients and providers, implementation choices can have major impact. While various implementation guides exist, a stepwise list of decision points covering the full implementation process and drawing explicitly on a sociotechnical conceptual framework does not exist.
Methods:
To facilitate real-world implementation of PROs in electronic health records (EHRs) for use in clinical practice, members of the EHR Access to Seamless Integration of Patient-Reported Outcomes Measurement Information System (PROMIS) Consortium developed structured PRO implementation planning tools. Each institution pilot tested the tools. Joint meetings led to the identification of critical sociotechnical success factors.
Results:
Three tools were developed and tested: (1) a PRO Planning Guide summarizes the empirical knowledge and guidance about PRO implementation in routine clinical care; (2) a Decision Log allows decision tracking; and (3) an Implementation Plan Template simplifies creation of a sharable implementation plan. Seven lessons learned during implementation underscore the iterative nature of planning and the importance of the clinician champion, as well as the need to understand aims, manage implementation barriers, minimize disruption, provide ample discussion time, and continuously engage key stakeholders.
Conclusions:
Highly structured planning tools, informed by a sociotechnical perspective, enabled the construction of clear, clinic-specific plans. By developing and testing three reusable tools (freely available for immediate use), our project addressed the need for consolidated guidance and created new materials for PRO implementation planning. We identified seven important lessons that, while common to technology implementation, are especially critical in PRO implementation.
A major challenge facing archaeologists is communicating our research to thepublic. Thankfully, new computational tools have enabled the testing andvisualization of complex ideas in an easily packageable format. In this articlewe illustrate not only how agent-based modeling provides a platform forcommunicating complex ideas, but also how these game-like computer models can beexplored and manipulated by members of the public therefore increasing theirengagement in archaeological explanations. We suggest that these new digitaltools serve as an excellent aid for education on the importance ofarchaeological sites and artifacts. To illustrate the above we walk the readerthrough a step-by-step pipeline of how to run an ABM model as an experiment andhow to export it into a form ready to be sent to SHPO and THPO offices in tandemwith reports. Ultimately, we hope that this work will help demystify thecomputational archaeology process and lead to more fluency in using agent-basedmodeling in research and outreach.
Formal models of past human societies informed by archaeological research have a high potential for shaping some of the most topical current debates. Agent-based models, which emphasize how actions by individuals combine to produce global patterns, provide a convenient framework for developing quantitative models of historical social processes. However, being derived from computer science, the method remains largely specialized in archaeology. In this paper and the associated tutorial, we provide a jargon-free introduction to the technique, its potential and limits as well as its diverse applications in archaeology and beyond. We discuss the epistemological rationale of using computational modeling and simulation, classify types of models, and give an overview of the main concepts behind agent-based modeling.
Archaeologists are using spatial data in increasingly sophisticated analyses and invoking more explicit considerations of space in their interpretations. Geographic information systems (GIS) have become standard technology for professional archaeologists in the collection and management of spatial data. Many calls have been made to develop and adapt digital geospatial technologies for interpretation and understanding past social dynamics, but this has been limited to some extent by the static nature of map-oriented GIS approaches. Here, we illustrate how coupling GIS with agent-based modeling (ABM) can assist with more dynamic explorations of past uses of space and geospatial phenomena.
Suicidal behaviour is common in acute psychiatric wards resulting in distress, and burden for patients, carers and society. Although psychological therapies for suicidal behaviour are effective in out-patient settings, there is little research on their effectiveness for in-patients who are suicidal.
Aims
Our primary objective was to determine whether cognitive–behavioural suicide prevention therapy (CBSP) was feasible and acceptable, compared with treatment as usual (TAU) for in-patients who are suicidal. Secondary aims were to assess the impact of CBSP on suicidal thinking, behaviours, functioning, quality of life, service use, cost-effectiveness and psychological factors associated with suicide.
Method
A single-blind pilot randomised controlled trial comparing TAU to TAU plus CBSP in in-patients in acute psychiatric wards who are suicidal (the Inpatient Suicide Intervention and Therapy Evaluation (INSITE) trial, trial registration: ISRCTN17890126). The intervention consisted of TAU plus up to 20 CBSP sessions, over 6 months continuing in the community following discharge. Participants were assessed at baseline and at 6 weeks and 6 months post-baseline.
Results
A total of 51 individuals were randomised (27 to TAU, 24 to TAU plus CBSP) of whom 37 were followed up at 6 months (19 in TAU, 18 in TAU plus CBSP). Engagement, attendance, safety and user feedback indicated that the addition of CBSP to TAU for in-patients who are acutely suicidal was feasible and acceptable while on in-patient wards and following discharge. Economic analysis suggests the intervention could be cost-effective.
Discussion
Psychological therapy can be delivered safely to patients who are suicidal although modifications are required for this setting. Findings indicate a larger, definitive trial should be conducted.
Declaration of interest
The trial was hosted by Greater Manchester Mental health NHS Trust (formerly, Manchester Mental Health and Social Care NHS Trust). The authors are affiliated to the University of Manchester, Greater Manchester Mental Health Foundation Trust, Lancashire Care NHS Foundation trust and the Manchester Academic Health Sciences Centre. Y.A. is a trustee for a North-West England branch of the charity Mind.
The topic of financial elder abuse is rather closer to home than I might have wished. During this research project, my 94-year-old mother, and then subsequently my 95-year-old stepfather, fell for a financial scam. The scam consisted of a letter arriving in the post telling my mother that she had won US$800,000 in the Publishers Clearing House (PCH) sweepstakes. All that mother had to do was pay the taxes of US$800 and a cheque would be sent for the US$800,000. This is, of course, where mother should have become suspicious. However, PCH does run a sweepstake prize, and the letter certainly looked legitimate, containing the logo of PCH. All that mother had to do was go to Western Union and telegraph the tax money; this, she did, even though my stepfather by then was suspicious and warned against this action. Needless to say, the winnings never arrived.
My sister and I probably never would have found out about this, as clearly my mother felt humiliated for falling for this scam, but for the fact that they were then inundated with telephone calls and further letters saying that they had won money. Not knowing how to stop the calls and the mail, mother eventually revealed what had happened to my sister. My sister and I were both horrified and felt guilty. We felt guilty because we had never thought to warn about scams of this nature. One of the reasons for not discussing this with them was because they did not have a computer, and both of us were unaware of the number of very sophisticated scams that are sent through the post.
As if this was not bad enough, our stepfather then fell for the follow-up scam. He received a letter from a ‘company’ indicating that they understood that mother had been scammed and they were now receiving nuisance telephone calls and letters, and that for a fee of US$300 the company would intervene and stop the calls and letters. He paid the fee. Luckily my sister found out about this in time to stop the payment. However, he then received nasty letters threatening legal action if he did not make the payment.
Here we compare scaled centrifuge modelling of gelifluction processes with earlier full-scale physical modelling experiments. The objective is to assess the validity of the centrifuge technique for cryogenic slope-process investigations. Centrifuge modelling allows correct self-weight stresses to be generated within a small-scale physical model by placing it in an elevated gravitational field. This paper describes an experiment in which a scaled frozen-slope model was thawed in a gravitational field equivalent to ten gravities. After four cycles of thawing, during which soil temperatures, pore pressures, thaw settlement and downslope soil displacements were continuously monitored, a series of marker columns were excavated to reveal profiles of soil movement. Comparison of these data with those from an earlier full-scale laboratory simulation experiment indicates that thaw-related gelifluction was successfully reproduced during centrifuge modelling. It is concluded that rates of soil shear strain during gelifluction were not time-dependent? since soil displacements in the centrifuge tests were of a similar magnitude to or greater than those observed in the much longer-duration full-scale simulation. This suggests that no transition occurred in soil behaviour from a frictional plastic to a true viscous fluid during the period of high moisture contents immediately following thaw.
To assess the safety against failure of rock slopes in cold regions, such as high mountain areas, where stability is potentially maintained by ice in rock discontinuities, the shear strength of ice-filled rock joints was investigated in a series of direct shear-box tests. To permit control and repeatability, the experiments were conducted using simulated rock specimens. These were cast in the laboratory using high-strength concrete. Laboratory measurements showed that at a constant rate of shearing, the interface shear strength between ice and a joint surface of repeatable roughness is a function of both temperature and normal stress.
Yellow mignonette (Reseda lutea (L.) # RESLU) is a broadleaf perennial weed that is native to the Mediterranean Basin and Asia Minor. It has been spread around the world and is widely recognized in Australia as a troublesome noxious weed in croplands. It is a problem in cropland and pastures because of its high seed output, extensive reproductive root system, ability to thrive under disturbed conditions, and high nitrate levels. While nitrate levels of 2.5 to 3.1% have been detected in plants during the rosette to early flower growth stages, when yellow mignonette is most palatable, no livestock injury or deaths have been reported. Yellow mignonette was first reported in Montana in 1958 but was not recognized as a weed problem until 1990. Since 1988 it has invaded several hundred hectares of small grains and alfalfa (Medicago sativa L.)-grass pastures in Central Montana and is spreading rapidly along gravel road shoulders.
Training for the clinical research workforce does not sufficiently prepare workers for today’s scientific complexity; deficiencies may be ameliorated with training. The Enhancing Clinical Research Professionals’ Training and Qualifications developed competency standards for principal investigators and clinical research coordinators.
Methods
Clinical and Translational Science Awards representatives refined competency statements. Working groups developed assessments, identified training, and highlighted gaps.
Results
Forty-eight competency statements in 8 domains were developed.
Conclusions
Training is primarily investigator focused with few programs for clinical research coordinators. Lack of training is felt in new technologies and data management. There are no standardized assessments of competence.
The translation of discoveries to drugs, devices, and behavioral interventions requires well-prepared study teams. Execution of clinical trials remains suboptimal due to varied quality in design, execution, analysis, and reporting. A critical impediment is inconsistent, or even absent, competency-based training for clinical trial personnel.
Methods
In 2014, the National Center for Advancing Translational Science (NCATS) funded the project, Enhancing Clinical Research Professionals’ Training and Qualifications (ECRPTQ), aimed at addressing this deficit. The goal was to ensure all personnel are competent to execute clinical trials. A phased structure was utilized.
Results
This paper focuses on training recommendations in Good Clinical Practice (GCP). Leveraging input from all Clinical and Translational Science Award hubs, the following was recommended to NCATS: all investigators and study coordinators executing a clinical trial should understand GCP principles and undergo training every 3 years, with the training method meeting the minimum criteria identified by the International Conference on Harmonisation GCP.
Conclusions
We anticipate that industry sponsors will acknowledge such training, eliminating redundant training requests. We proposed metrics to be tracked that required further study. A separate task force was composed to define recommendations for metrics to be reported to NCATS.