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Patients with posttraumatic stress disorder (PTSD) exhibit smaller regional brain volumes in commonly reported regions including the amygdala and hippocampus, regions associated with fear and memory processing. In the current study, we have conducted a voxel-based morphometry (VBM) meta-analysis using whole-brain statistical maps with neuroimaging data from the ENIGMA-PGC PTSD working group.
Methods
T1-weighted structural neuroimaging scans from 36 cohorts (PTSD n = 1309; controls n = 2198) were processed using a standardized VBM pipeline (ENIGMA-VBM tool). We meta-analyzed the resulting statistical maps for voxel-wise differences in gray matter (GM) and white matter (WM) volumes between PTSD patients and controls, performed subgroup analyses considering the trauma exposure of the controls, and examined associations between regional brain volumes and clinical variables including PTSD (CAPS-4/5, PCL-5) and depression severity (BDI-II, PHQ-9).
Results
PTSD patients exhibited smaller GM volumes across the frontal and temporal lobes, and cerebellum, with the most significant effect in the left cerebellum (Hedges’ g = 0.22, pcorrected = .001), and smaller cerebellar WM volume (peak Hedges’ g = 0.14, pcorrected = .008). We observed similar regional differences when comparing patients to trauma-exposed controls, suggesting these structural abnormalities may be specific to PTSD. Regression analyses revealed PTSD severity was negatively associated with GM volumes within the cerebellum (pcorrected = .003), while depression severity was negatively associated with GM volumes within the cerebellum and superior frontal gyrus in patients (pcorrected = .001).
Conclusions
PTSD patients exhibited widespread, regional differences in brain volumes where greater regional deficits appeared to reflect more severe symptoms. Our findings add to the growing literature implicating the cerebellum in PTSD psychopathology.
Anxiety disorders are among the most prevalent mental disorders. However, only a minority of patients receives adequate psychotherapeutic treatment despite strong empirical evidence for the efficacy of CBT in anxiety disorders (Marcks et al. Psychiatr Serv 2009; 60 823-830). App-based psychotherapy can help to reduce this massive treatment gap.
Objectives
We aimed at evaluating the efficacy of an app-based treatment for anxiety disorders including exposure in virtual reality.
Methods
The randomized controlled trial was conducted in two university outpatient treatment centers in Northern Germany. Patients were diagnosed with agoraphobia (AP; with or without panic disorder; n=103), panic disorder (PD; n=84) or social anxiety disorder (SAD; n=110) and were randomly assigned to either the app-based intervention or treatment as usual (up to 6 sessions of supportive therapy). The app was developed based on evaluated CBT manuals and includes 14 hours of audio and video content and 15 disorder specific virtual reality exposure scenarios. Participants in the intervention groups also received two appointments with a therapist during the app-based treatment. Primary outcome was the change in Beck Anxiety Inventory (BAI) score pre to post (after 6 months). Mixed ANOVAs were conducted in intention to treat and completer analyses. Secondary outcomes were disorder specific questionnaires (Liebowitz Social Anxiety Scale LSAS for SAD and Panic and Agoraphobia Scale PAS for AP and PD) and health related quality of life measured with a single item (L-1).
Results
In the ITT analysis, the interaction effect between group and time was significant in patients with AP as well as in patients with PD (AP: p=.014, partial η²=.06; PD: p=.028, partial η²=.06). This indicates a stronger improvement of symptoms in the intervention group compared to the control group. In patients with SAD, there was no significant interaction effect (p=.101, partial η²=.03). The disorder specific measures LSAS and PAS showed a significantly stronger decrease in the intervention group than in the control group for each of the specific disorders. Concerning quality of life, a stronger improvement in the intervention group was only found in patients with PD.
Conclusions
A stronger symptom reduction in the app-based intervention group compared to the control group could be found in patients with AP (BAI/PAS), PD (BAI/PAS) and SAD (LSAS). This is particularly remarkable as the app was compared to an active control group with up to 6 sessions of psychotherapy. Effect sizes were comparable to those found in studies comparing face-to-face CBT to an active control group. The lack of an intervention-specific effect on BAI scores in patients with SAD might be due to the poor sensitivity of the BAI for the specific symptoms of SAD.
Rest-frame far-ultraviolet spectra are fundamental to our understanding of star-forming galaxies, providing a unique window on massive star populations (MSs), chemical evolution, feedback processes, and reionization. JWST is ushering in a new era, pushing the FUV frontier beyond z=10. The success of such endeavors hinges on a comprehensive understanding of the MSs and gas conditions that power the observed spectra. The COS Legacy Archive Spectroscopic SurveY (CLASSY) is a powerful and promising solution providing high-quality, high-resolution FUV spectra of 45 nearby star-forming galaxies. The spectra contain a suite of features that simultaneously characterize the MSs that populate metal-poor galaxies, physical properties of large-scale outflows, and chemical abundance patterns. The CLASSY sample is consistent with the z 0 mass-metallicity relationship and spans 1.5 dex in metallicity. These unique properties make CLASSY the benchmark training set for studies of MSs in star-forming galaxies both across cosmic time and connecting metal-poor to metal-rich populations.
Until the past half-century, all agriculture and land management was framed by local institutions strong in social capital. But neoliberal forms of development came to undermine existing structures, thus reducing sustainability and equity. The past 20 years, though, have seen the deliberate establishment of more than 8 million new social groups across the world. This restructuring and growth of rural social capital within specific territories is leading to increased productivity of agricultural and land management systems, with particular benefits for those previously excluded. Further growth would occur with more national and regional policy support.
An experiment was conducted to test the hypothesis that meat products have digestible indispensable amino acid scores (DIAAS) >100 and that various processing methods will increase standardised ileal digestibility (SID) of amino acids (AA) and DIAAS. Nine ileal-cannulated gilts were randomly allotted to a 9 × 8 Youden square design with nine diets and eight 7-d periods. Values for SID of AA and DIAAS for two reference patterns were calculated for salami, bologna, beef jerky, raw ground beef, cooked ground beef and ribeye roast heated to 56, 64 or 72°C. The SID of most AA was not different among salami, bologna, beef jerky and cooked ground beef, but was less (P < 0·05) than the values for raw ground beef. The SID of AA for 56°C ribeye roast was not different from the values for raw ground beef and 72°C ribeye roast, but greater (P < 0·05) than those for 64°C ribeye roast. For older children, adolescents and adults, the DIAAS for all proteins, except cooked ground beef, were >100 and bologna and 64°C ribeye roast had the greatest (P < 0·05) DIAAS. The limiting AA for this age group were sulphur AA (beef jerky), leucine (bologna, raw ground beef and cooked ground beef) and valine (salami and the three ribeye roasts). In conclusion, meat products generally provide high-quality protein with DIAAS >100 regardless of processing. However, overcooking meat may reduce AA digestibility and DIAAS.
Objectives: A meta-analysis of the extent, nature and pattern of memory performance in behavioral variant frontotemporal dementia (bvFTD). Multiple observational studies have challenged the relative sparing of memory in bvFTD as stated in the current diagnostic criteria. Methods: We performed a meta-analytic review covering the period 1967 to February 2017 of case-control studies on episodic memory in bvFTD versus control participants (16 studies, 383 patients, 603 control participants), and patients with bvFTD versus those with Alzheimer’s disease (AD) (20 studies, 452 bvFTD, 874 AD). Differences between both verbal and non-verbal working memory, episodic memory learning and recall, and recognition memory were examined. Data were extracted from the papers and combined into a common metric measure of effect, Hedges’ d. Results: Patients with bvFTD show large deficits in memory performance compared to controls (Hedges’ d –1.10; 95% confidence interval [CI] [–1.23, –0.95]), but perform significantly better than patients with AD (Hedges’ d 0.85; 95% CI [0.69, 1.03]). Learning and recall tests differentiate best between patients with bvFTD and AD (p<.01). There is 37–62% overlap in test scores between the two groups. Conclusions: This study points to memory disorders in patients with bvFTD, with performance at an intermediate level between controls and patients with AD. This indicates that, instead of being an exclusion criterion for bvFTD diagnosis, memory deficits should be regarded as a potential integral part of the clinical spectrum. (JINS, 2018, 24, 593–605)
Residents in long-term care (LTC) often require physical rehabilitation (PR) to maintain/improve physical function. This scoping review described the breadth of literature regarding PR in LTC to date, synthesizing PR interventions that have been evaluated, outcomes used, and tools for determining service eligibility. A structured search, conducted in six licensed databases and grey literature, identified 381 articles for inclusion. Most interventions were delivered and evaluated at the resident level and typically were multicomponent exercise programs. Performance-based measures, activities of daily living, and mood were the most frequently reported outcomes. A key knowledge gap was PR in relation to goals, such as quality of life. Future studies should reflect medically complex residents who live in LTC, and length of residents’ stay should be differentiated. Intervention studies should also explore realistic delivery methods; moreover, tool development for determining service eligibility is necessary to ensure equality in rehabilitative care across the LTC sector.
We used a web-based mixed methods survey (HowsYourHealth – Frail) to explore the health of frail older (78% age 80 or older) adults enrolled in a home-based primary care program in Vancouver, Canada. Sixty per cent of eligible respondents participated, representing over one quarter (92/350, 26.2%) of all individuals receiving the service. Despite high levels of co-morbidity and functional dependence, 50 per cent rated their health as good, very good, or excellent. Adjusted odds ratios for positive self-rated health were 7.50, 95 per cent CI [1.09, 51.81] and 4.85, 95 per cent CI [1.02, 22.95] for absence of bothersome symptoms and being able to talk to family or friends respectively. Narrative responses to questions about end of life and living with illness are also described. Results suggest that greater focus on symptom management, and supporting social contact, may improve frail seniors’ health.
The history of social work in the United Kingdom is a long and complex one, and there are no signs of it getting less complex. If the theory and practice of UK social work is of interest to an international audience, it is not just because of the hegemony of the English language, but also because it has often been at the forefront of changes – for good and ill, perhaps. If there is something to learn from the UK experience, it might be as much from the wrong turns and difficulties of the occupation in that divided realm, as from the advances in thinking and practice. This chapter focuses on the contemporary position of social work in the UK, and on the challenges to what is seen as a managerial-technicist version of social work (Harlow, 2003). If the UK is to be seen as at the forefront of the New Public Management and of managerialist reforms in the 1980s, those in other countries and contexts might seek to avoid some of the problems of an ‘early adopter’. It will be apparent here, however, that the future course of the social work occupation in the UK is by no means fully charted. At best we can point to certain possibilities and to social imaginaries that may prove to be the basis for revised forms of practice, however liminal these are. In this discussion the focus will be the degree of professional autonomy of social workers as an occupational group as a feature of these possibilities. First, we focus on the situation from the 1990s to the present day in which this managerial-technicist version of social work takes root and flourishes. Second, we focus on three alternatives that have emerged in recent years. In doing so, we do not intend to provide an indication of the likely direction of travel for UK social work, nor do we assume that these alternatives are the only ones available; we hope merely to draw attention to possible alternatives that might be worth considering and supporting.
The ‘profession’ of social work in the UK can be regarded as occupying a favourable position, in that social work is a protected title and only those who have undergone graduate-level education in social work, in approved courses, can describe themselves as ‘social workers’.
Rett syndrome (RTT) is a severe neurodevelopmental disorder of girls, caused by mutations in the X-linked MECP2 gene. Worldwide recognition of the RTT clinical phenotype in the early 1980's allowed many cases to be diagnosed, and established RTT as one of the most common mental retardation syndromes in females. The years since then led to a refinement of the phenotype and the recent elaboration of Revised Diagnostic Criteria (RDC). Here, we study the impact of the presence versus the absence of the use of diagnostic criteria from the RDC to make a diagnosis of RTT on MECP2 mutation detection in Canadian patients diagnosed and suspected of having RTT.
Methods:
Using dHPLC followed by sequencing in all exons of the MECP2 gene, we compared mutation detection in a historic cohort of 35 patients diagnosed with RTT without the use of specific diagnostic criteria to a separate more recent group of 101 patients included on the basis of strict fulfillment of the RDC.
Results:
The MECP2 mutation detection rate was much higher in subjects diagnosed using a strict adherence to the RDC (20% vs. 72%).
Conclusions:
These results suggest that clinical diagnostic procedures significantly influence the rate of mutation detection in RTT, and more generally emphasize the importance of diagnostic tools in the assessment of neurobehavioral syndromes.
Edited by
Susanna Pietropaolo, Centre National de la Recherche Scientifique (CNRS), Paris,Frans Sluyter, University of Portsmouth,Wim E. Crusio, Centre National de la Recherche Scientifique (CNRS), Paris
One of the most influential German-language writers of the late twentieth century, Max Frisch (1911-1991) not only has canonical status in Europe, but has also been well received in the English-speaking world. English translations of his works are available in multiple recent editions. Frisch was a recipient of both the Büchner Award (1958), and the Peace Prize of the German Book Trade (1976); his body of work explores questions of identity, alienation, and ethics in modern society. He is best known for the plays 'Andorra' (1961), a seminal drama that examines indifference and mass psychology in the context of the Shoah and continues to be produced by theaters around the world, and 'Biedermann und die Brandstifter' (1958), another worldwide success and one of the most frequently used texts in advanced undergraduate German courses in the US, as well as for his novels 'Stiller' (1954), 'Homo Faber' (1957), and 'Mein Name sei Gantenbein' (1964). Yet Frisch has only recently begun to receive the sustained scholarly attention he deserves: neither a comprehensive introductory volume to nor a collaborative handbook on the works of Frisch is available in English, a situation that this volume redresses. Contributors: Régine Battiston, Olaf Berwald, Amanda Charitina Boyd, Daniel de Vin, Céline Letawe, Walter Obschlager, John D. Pizer, Beate Sandberg, Caroline Schaumann, Frank Schaumann, Walter Schmitz, Margit Unser, Klaus van den Berg, Ruth Vogel-Klein, Paul A. Youngman. Olaf Berwald is Associate Professor of German and Chair of the Department of Modern and Classical Languages and Literatures at the University of North Dakota.
Edited by
Olaf Berwald, Associate Professor of German and Chair of the Department of Modern and Classical Languages and Literatures at the University of North Dakota
In Frisch's narrative Montauk (1975), various memories and episodes from the narrator's life are alternately presented from a first-person and a third-person point of view. throughout the text, the writing process of this specific book, and of literature in general, are negotiated in a self-referential discourse. The time frames change frequently. Fragmentary and constantly shifting memories that reach back into childhood are interwoven with a present-day plot set in the United States. This plot shows the sixty-two-year-old narrator “Max” in 1974 with Lynn, a young American woman whom he met at his New York publisher's office and with whom he spends a few days in New York City and a weekend at the shore, in Montauk, on the far eastern end of Long island.
The work's narrative structure is highly complex. The pages written in the past tense are partially grouped according to thematic clusters and partially follow a loose associative pattern. The thematic segments present aspects of the life of “Max,” a Swiss writer, in brief episodes or diachronically under thematic titles such as “architecture” or “fame,” and shed light on his experiences and character traits. Another technique of weaving the diverse segments together uses subtle associations that are triggered by persons, places, objects, time references, questions, single words, and quotations, associations that establish parallels between the present and a remembered past. Particularly memories of other people are interwoven in an associative manner. They provide connections to the narrated time in Montauk.
Edited by
Olaf Berwald, Associate Professor of German and Chair of the Department of Modern and Classical Languages and Literatures at the University of North Dakota
Edited by
Olaf Berwald, Associate Professor of German and Chair of the Department of Modern and Classical Languages and Literatures at the University of North Dakota
Frisch's novel stiller (1954) begins with an exclamation: “Ich bin nicht Stiller!” (I'm not Stiller!) The novel's protagonist, Anatol Stiller, a Swiss sculptor who has taken on a new identity and moved to the United States and then to Mexico, returns to his home country and is arrested upon his arrival after an altercation with a Swiss border guard who questions the validity of his identification papers. The novel consists of two parts, a journal that Stiller writes in a series of notebooks while in pre-trial confinement, and an account in which the district attorney, who had become a friend of Stiller's, outlines Stiller's life after his release. Throughout Stiller's notebooks, the prisoner claims that his name is not Stiller, but James White, a position that he continues to insist on even when his wife confronts him. Like many of Frisch's works, the novel negotiates conflicts between subjective and external reality and questions the stability of selfhood. The notebooks display a clear structure. Segments on Stiller's wife Julika and on the district attorney Rolf and his wife Sibylle alternate with reflections, dialogues, and stories that Stiller/White invents for his prison guard in order to entertain him while at the same time revealing a lot of himself.
Edited by
Olaf Berwald, Associate Professor of German and Chair of the Department of Modern and Classical Languages and Literatures at the University of North Dakota
Edited by
Olaf Berwald, Associate Professor of German and Chair of the Department of Modern and Classical Languages and Literatures at the University of North Dakota
Max Frisch's tagebücher mainly consist of Tagebuch 1946–1949 (1950) and Tagebuch 1966–1971 (1972). The first volume received close attention only after the second was published and rapidly became a bestseller in 1972, with extremely positive reviews by Rudolf Hartung and Marcel Reich-Ranicki in Die Zeit and by Hans Mayer in Der Spiegel. Thus, it is not surprising that the first volume to be translated into English, in 1974, was the Tagebuch 1966–1971 (under the English title Sketchbook 1966–1971), followed a few years later, in 1977, by the Tagebuch 1946–1949 (Sketchbook 1946–1949), more than twenty-five years after its first publication in German.
Yet Tagebuch 1946–1949 was not the first Tagebuch written by Max Frisch. Indeed, besides the Tagebuch with Marion—the first part of the Tagebuch 1946–1949, covering the years 1946 and 1947, which had already been published in 1947—Frisch had written Blätter aus dem Brotsack (Pages from the Knapsack) in 1939, which was his first longer prose work after the novels Jürg Reinhart (1934) and Antwort aus der Stille (An Answer from the Silence, 1937). Blätter aus dem Brotsack was also the first work that Max Frisch wrote after he had burned his unpublished manuscripts in 1937 and had decided never to write again (Tb 1, 588). As Frisch explained later in an interview with Rolf Kieser, in this very particular situation he naturally chose the diary form because he did not have enough time for longer literary forms.