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England's primary care service for psychological therapy (Improving Access to Psychological Therapies [IAPT]) treats anxiety and depression, with a target recovery rate of 50%. Identifying the characteristics of patients who achieve recovery may assist in optimizing future treatment. This naturalistic cohort study investigated pre-therapy characteristics as predictors of recovery and improvement after IAPT therapy.
Methods
In a cohort of patients attending an IAPT service in South London, we recruited 263 participants and conducted a baseline interview to gather extensive pre-therapy characteristics. Bayesian prediction models and variable selection were used to identify baseline variables prognostic of good clinical outcomes. Recovery (primary outcome) was defined using (IAPT) service-defined score thresholds for both depression (Patient Health Questionnaire [PHQ-9]) and anxiety (Generalized Anxiety Disorder [GAD-7]). Depression and anxiety outcomes were also evaluated as standalone (PHQ-9/GAD-7) scores after therapy. Prediction model performance metrics were estimated using cross-validation.
Results
Predictor variables explained 26% (recovery), 37% (depression), and 31% (anxiety) of the variance in outcomes, respectively. Variables prognostic of recovery were lower pre-treatment depression severity and not meeting criteria for obsessive compulsive disorder. Post-therapy depression and anxiety severity scores were predicted by lower symptom severity and higher ratings of health-related quality of life (EuroQol questionnaire [EQ5D]) at baseline.
Conclusion
Almost a third of the variance in clinical outcomes was explained by pre-treatment symptom severity scores. These constructs benefit from being rapidly accessible in healthcare services. If replicated in external samples, the early identification of patients who are less likely to recover may facilitate earlier triage to alternative interventions.
Both of Spinoza’s major political works make frequent use of the concept of right (jus). However, his understanding of right – both natural right and political right – is not moralistic. That is, to have (a) right is not an intrinsic moral status, such that others have a moral obligation either to provide some benefit or to avoid interference with the rightsholder. For Spinoza, if someone lacks the actual power to take some action or secure some benefit, they also lack the right to take that action or obtain that benefit. The same point applies to political authorities: when a political authority lacks the power to enact some law, it is simply false that they have the right to enact that law. Spinoza holds that in our political thinking, we must confront the actual distribution of power in the world, not “a Fantasy, possible only in a Utopia, or in the golden age of the Poets” (TP1.1).
From early in his philosophical career, Spinoza took a central part of his project to involve identifying the nature and scope of human power. For, he argues, “The better the mind understands its own powers, the more easily it can direct itself and propose rules to itself” (TIE[40]). Thus, the practical goals of living well, and of building a stable, well-functioning social order, are both intimately connected to the metaphysics of power. This entry provides an overview of Spinoza’s account of power, both in his metaphysics and in his politics.
Many of Spinoza’s arguments, ranging from his metaphysics to his political philosophy, draw on claims about the relationship between part (pars) and whole (totus). This entry surveys Spinoza’s views about the metaphysics of parts and wholes, as well as the various ways that mereological concepts figure in different elements of his system.
“Singular thing” (res singulares) is one of the terms Spinoza uses to denote finite particulars. The term figures prominently in most of his philosophical works (with the exception of the TTP, where it figures only briefly in the account of prophecy, and the TP, where the term goes unused). However, its precise meaning evolves from its earliest appearance in the TIE to its final appearance in the Ethics. In the Ethics, the definition of the term (i) stipulates that singular things are finite and (ii) specifies the conditions under which many things compose one singular thing. However, in Spinoza’s earlier writings, the term is not restricted to finite and mutable things, nor is it associated with the composition of one (singular) thing from many distinct things. This short entry traces those shifts in meaning.
Does Anne Conway (1631–79) hold that the created world consists of a single underlying substance? Some have argued that she does; others have argued that she is a priority monist and so holds that there are many created substances, but the whole created world is ontologically prior to each particular creature. Against both of these proposals, this article makes the case for a substance pluralist interpretation of Conway: individual creatures are distinct substances, and the whole created world is not ontologically prior to the individual creatures that compose it. The basic argument for such a view draws on Conway's claims about the freedom and moral responsibility of individual creatures. The pluralist reading is straightforwardly compatible with these claims, while the monistic readings are not.
Neoliberalism has permeated every sphere of social life, including education and language learning, seeking to produce a particular kind of subject, homo economicus, with the dispositions required to manage the self as an economic project. This article unravels the workings of the unfulfilled promise of neoliberal English education and its damaging consequences on a high-achieving female university graduate in the context of contemporary Hong Kong. Combining Marxist and Foucauldian perspectives, while simultaneously drawing on Goffman's concepts of stigma and spoiled identity, our analysis is informed by positioning theory and captures the impact of what we have termed the English language gaze on our informant's sense of self. Seen through a Foucauldian lens, the data reveal the extent, but also the limits, of her assimilation of neoliberal governmentality, while the Marxist lens allows us to account for her plight in terms of alienation and the resulting stigma of a spoiled identity. (Neoliberalism, governmentality, alienation, stigma, spoiled identity, English learning, English language gaze)*
The involvement of citizens in the production and creation of public services has become a central tenet for administrations internationally. In Scotland, co-production has underpinned the integration of health and social care via the Public Bodies (Joint Working) (Scotland) Act 2014. We report on a qualitative study that examined the experiences and perspectives of local and national leaders in Scotland on undertaking and sustaining co-production in public services. By adopting a meso and macro perspective, we interviewed senior planning officers from eight health and social care partnership areas in Scotland and key actors in national agencies. The findings suggest that an overly complex Scottish governance landscape undermines the sustainability of co-production efforts. As part of a COVID-19 recovery, both the implementation of meaningful co-production and coordinated leadership for health and social care in Scotland need to be addressed, as should the development of evaluation capacities of those working across health and social care boundaries so that co-production can be evaluated and report to inform the future of the integration agenda.
Globally, giant miscanthus (Miscanthus × giganteus J.M. Greef & Deuter ex Hodkinson & Renvoize [sacchariflorus × sinensis]) is used as a biofuel crop due to its ability to persist in a wide range of climates. However, little work has assessed this plant’s ability to invade and persist in wetland habitats. In outdoor mesocosms, we examined M. × giganteus’s ability to grow in simulated wetland versus upland habitats and examined chemical control strategies for both habitats using aquatic-labeled herbicides. Miscanthus × giganteus growth was consistently greater in simulated wetland habitats, with wetland plants 2.4 to 3 times taller than upland plants at 6 wk after treatment (WAT) and 2.8 to 3.3 times taller than upland plants at 12 WAT. Miscanthus × giganteus aboveground biomass was 12.7 to 17.7 times greater in wetland- versus upland-grown plants at 6 WAT and 9.6 to 12.5 times greater at 12 WAT. Belowground biomass was 4.5 to 10.7 times greater in wetland versus upland grown plants at 6 WAT and 4.0 to 6.1 times greater at 12 WAT. Miscanthus × giganteus belowground biomass was always greater than aboveground in both habitats at 6 (6.0 times greater in wetlands and 2.9 times greater in uplands) and 12 WAT (3.8 times greater in wetlands and 1.3 times greater in uplands). Generally, all herbicide treatments reduced M. × giganteus height (66% to 100% reduction) and biomass (84% to 100%) compared with nontreated plants at 12 WAT; however, glyphosate (5,716.3 g ai ha−1) and imazapyr (1,120.8 g ai ha−1) performed better than imazamox (560.4 g ai ha−1) and penoxsulam (98.6 g ai ha−1). This is the first work to provide evidence that M. × giganteus can be chemically controlled in wetland habitats. Furthermore, this is the first work to show that penoxsulam (an acetolactate synthase–inhibiting herbicide) can reduce M. × giganteus growth in upland or wetland habitats.
Healthcare workers (HCWs) are a high-priority group for coronavirus disease 2019 (COVID-19) vaccination and serve as sources for public information. In this analysis, we assessed vaccine intentions, factors associated with intentions, and change in uptake over time in HCWs.
Methods:
A prospective cohort study of COVID-19 seroprevalence was conducted with HCWs in a large healthcare system in the Chicago area. Participants completed surveys from November 25, 2020, to January 9, 2021, and from April 24 to July 12, 2021, on COVID-19 exposures, diagnosis and symptoms, demographics, and vaccination status.
Results:
Of 4,180 HCWs who responded to a survey, 77.1% indicated that they intended to get the vaccine. In this group, 23.2% had already received at least 1 dose of the vaccine, 17.4% were unsure, and 5.5% reported that they would not get the vaccine. Factors associated with intention or vaccination were being exposed to clinical procedures (vs no procedures: adjusted odds ratio [AOR], 1.39; 95% confidence interval [CI], 1.16–1.65) and having a negative serology test for COVID-19 (vs no test: AOR, 1.46; 95% CI, 1.24–1.73). Nurses (vs physicians: AOR, 0.24; 95% CI, 0.17–0.33), non-Hispanic Black (vs Asians: AOR, 0.35; 95% CI, 0.21–0.59), and women (vs men: AOR, 0.38; 95% CI, 0.30–0.50) had lower odds of intention to get vaccinated. By 6-months follow-up, >90% of those who had previously been unsure were vaccinated, whereas 59.7% of those who previously reported no intention of getting vaccinated, were vaccinated.
Conclusions:
COVID-19 vaccination in HCWs was high, but variability in vaccination intention exists. Targeted messaging coupled with vaccine mandates can support uptake.
To determine the changes in severe acute respiratory coronavirus virus 2 (SARS-CoV-2) serologic status and SARS-CoV-2 infection rates in healthcare workers (HCWs) over 6-months of follow-up.
Design:
Prospective cohort study.
Setting and participants:
HCWs in the Chicago area.
Methods:
Cohort participants were recruited in May and June 2020 for baseline serology testing (Abbott anti-nucleocapsid IgG) and were then invited for follow-up serology testing 6 months later. Participants completed monthly online surveys that assessed demographics, medical history, coronavirus disease 2019 (COVID-19), and exposures to SARS-CoV-2. The electronic medical record was used to identify SARS-CoV-2 polymerase chain reaction (PCR) positivity during follow-up. Serologic conversion and SARS-CoV-2 infection or possible reinfection rates (cases per 10,000 person days) by antibody status at baseline and follow-up were assessed.
Results:
In total, 6,510 HCWs were followed for a total of 1,285,395 person days (median follow-up, 216 days). For participants who had baseline and follow-up serology checked, 285 (6.1%) of the 4,681 seronegative participants at baseline seroconverted to positive at follow-up; 138 (48%) of the 263 who were seropositive at baseline were seronegative at follow-up. When analyzed by baseline serostatus alone, 519 (8.4%) of 6,194 baseline seronegative participants had a positive PCR after baseline serology testing (4.25 per 10,000 person days). Of 316 participants who were seropositive at baseline, 8 (2.5%) met criteria for possible SARS-CoV-2 reinfection (ie, PCR positive >90 days after baseline serology) during follow-up, a rate of 1.27 per 10,000 days at risk. The adjusted rate ratio for possible reinfection in baseline seropositive compared to infection in baseline seronegative participants was 0.26 (95% confidence interval, 0.13–0.53).
Conclusions:
Seropositivity in HCWs is associated with moderate protection from future SARS-CoV-2 infection.
It is generally acknowledged that alternative strategies are required to enable children with disability to access storytelling activities. In this study, we sought to analyse the benefits of one such strategy: an arts-based multisensory story and rhyme program delivered to children with Down syndrome and autism spectrum disorder. In order to determine the engagement and impact of the program on the participants, data were collected through a series of multisensory session observations, focus group interviews with parents of participants, and interviews with performing artists delivering the program. The findings of this study revealed multiple benefits of using sensory stimuli to engage children with disability in storytelling processes, including increased engagement, focus, and interaction with other children and family members. The performing artists used their knowledge and skills to create an engaging environment that was responsive to the children’s needs. It was observed that language development could be further enhanced by integrating written text into the performance and increasing the use of nonverbal communication methods. Further, the engagement of siblings without disability in this program suggested that it could be developed to be inclusive of children with and without disability.
The loss of methyl bromide led vegetable growers to rely more heavily on herbicides to control weeds. Although herbicides can be effective, limited options in vegetable production challenge growers. Identifying new, effective tools to be applied over plastic mulch before planting, for improved weed control with minimal crop injury, would be beneficial. The objective of these experiments was to evaluate the persistence of preplant applications of glyphosate (1,125 or 2,250 g ae ha−1) plus 2,4-D (1,065 or 2,130 g ae ha−1) or dicamba (560 g ae ha−1) over plastic mulch, using analytical techniques and subsequent yellow squash and watermelon response. Glyphosate and 2,4-D were not analytically detected at damaging concentrations on plastic mulch when at least 3.5 cm of rainfall was received after application and before planting. In addition, bioassay results showing less than 10% visual injury for either squash and watermelon, with no growth or yield suppression observed, supported analytical results. In contrast, dicamba concentrations on plastic mulch, regardless of rainfall amount or time between application and planting, remained at damaging levels. Squash yields were reduced by dicamba applied 1 to 30 d before planting, whereas watermelon was more resilient. 2,4-D plus glyphosate applied preplant over plastic mulch can provide an additional herbicide option for vegetable growers. More research is needed to understand the impact of residual activity of 2,4-D when transplants land directly in holes in plastic mulch at the time of application. The relationship of dicamba with plastic mulch is complex, because the herbicide cannot be easily removed by rainfall. Thus, dicamba should not be included in a weed management system in plasticulture vegetable production.
Agronomic crops engineered with resistance to 2,4-D or dicamba have been commercialized and widely adopted throughout the United States. Because of this, increased use of these herbicides in time and space has increased damage to sensitive crops. From 2014 to 2016, cucumber and cantaloupe studies were conducted in Tifton, GA, to demonstrate how auxinic herbicides (namely, 2,4-D or dicamba), herbicide rate (1/75 or 1/250 field use), and application timing (26, 16, and 7 d before harvest [DBH] of cucumber; 54, 31, and 18 DBH of cantaloupe) influenced crop injury, growth, yield, and herbicide residue accumulation in marketable fruit. Greater visual injury, reductions in vine growth, and yield loss were observed at higher rates when herbicides were applied during early-season vegetative growth compared with late-season with fruit development. Dicamba was more injurious in cucumber, whereas cantaloupe responded similarly to both herbicides. For cucumber, total fruit number and relative weights were reduced (16% to 19%) when either herbicide was applied at the 1/75 rate 26 DBH. Cantaloupe fruit weight was also reduced 21% and 10% when either herbicide was applied at the 1/75 rate 54 or 31 DBH, respectively. Residue analysis noted applications made closer to harvest were more likely to be detectable in fruit than earlier applications. In cucumber, dicamba was detected at both rates when applied 7 DBH, whereas in cantaloupe, it was detected at both rates when applied 18 or 31 DBH in 2016 and at the 1/75 rate applied 18 or 31 DBH in 2014. Detectable amounts of 2,4-D were not observed in cucumber but were detected in cantaloupe when applied at either rate 18 or 31 DBH. Although early-season injury will more likely reduce cucumber or cantaloupe yields, the quantity of herbicide residue detected will be most influenced by the time interval between the off-target incident and sampling.
Jahnsite-(CaMnZn), CaMn2+Zn2Fe3+2(PO4)4(OH)2⋅8H2O, is a new jahnsite-group mineral associated with alteration of phosphophyllite at the Hagendorf-Süd pegmatite, Bavaria. It forms as thin yellow crusts and brown epitactic growths on altered phosphophyllite, both of which comprise lath-like crystals in orthogonal orientation, up to 100 μm long. The crystals contain intergrowths of jahnsite-(CaMnZn) and jahnsite-(CaMnMn) on a scale of ~50 μm. The calculated density is 2.87 g cm−3 based on the empirical formula. Optically it is biaxial (–), with α = 1.675(2), β = 1.686(2) and γ = 1.691(2) (white light). The calculated 2V is 68°. Dispersion could not be observed, and the optical orientation is Z = b. Pleochroism was imperceptible. Electron microprobe analyses together with results from Mössbauer spectroscopy gives the formula (Ca0.59Mn0.24)Σ0.83Mn(Zn0.74Mn2+0.48Mg0.18Fe2+0.13Fe3+0.47)Σ2Fe3+2(P0.995O4)4(OH)2.03(H2O)7.97.
Jahnsite-(CaMnZn) is monoclinic, P2/a, with a = 15.059(1), b = 7.1885(6), c = 10.031(2) Å, β = 111.239(8)° and V = 1012.1(2) Å3. The recent International Mineralogical Association approved nomenclature system for jahnsite-group minerals was applied to establish jahnsite-(CaMnZn) from the empirical formula. The structural flexibility of jahnsite-group minerals to accommodate cations of quite different sizes in the X and M1 sites is discussed in terms of rotations about the 7 Å axis of two independent octahedra centred at the M3 sites.
Previous research in clinical, community, and school settings has demonstrated positive outcomes for the Secret Agent Society (SAS) social skills training program. This is designed to help children on the autism spectrum become more aware of emotions in themselves and others and to ‘problem-solve’ complex social scenarios. Parents play a key role in the implementation of the SAS program, attending information and support sessions with other parents and providing supervision, rewards, and feedback as their children complete weekly ‘home mission’ assignments. Drawing on data from a school-based evaluation of the SAS program, we examined whether parents’ engagement with these elements of the intervention was linked to the quality of their children’s participation and performance. Sixty-eight 8–14-year-olds (M age = 10.7) with a diagnosis of autism participated in the program. The findings indicated that ratings of parental engagement were positively correlated with children’s competence in completing home missions and with the quality of their contribution during group teaching sessions. However, there was a less consistent relationship between parental engagement and measures of children’s social and emotional skill gains over the course of the program.
John Gray widens the perspective to look at the fear of insecurity as it has spread in recent times across the European continent from Italy to Hungary. He details the various reactions to migrants from the Middle East and the reforms and policy decisions they have created at the state level. His argument is that the security state has transcended politics. With piercing insights, he examines the populism of France’s Macron and asks whether Russia’s Putin is a Hobbesian strategist, and if so, what that suggests for geopolitical strategies from the US, China, and elsewhere.
Flowering rush (Butomus umbellatus L.) is an invasive aquatic and wetland plant capable of developing monotypic stands in emergent and submersed sites. This plant can rapidly outcompete native vegetation and impede human practices by reducing recreation (boating, fishing, and skiing) and disrupting agricultural use of water resources (irrigation canals). Mechanical removal practices occurring biweekly, monthly, bimonthly, and once per growing season were compared with chemical control with diquat applied sequentially at 0.19 ppmv ai for two consecutive months over 2 yr (2016 and 2017). Biweekly removal gave the most consistent control of B. umbellatus biomass and propagules. Diquat application along with monthly and bimonthly clippings gave varying degrees of B. umbellatus control. Clipping once per growing season did not control B. umbellatus when compared with reference plants, while clipping B. umbellatus every 2 wk (biweekly) controlled rush propagules most effectively. However, it is unlikely this method will be sufficient as a stand-alone control option due to the slow speed of harvester boats, the potential these boats have to spread B. umbellatus propagules to more sites, and the expense of mechanical operations. However, clipping could be used as part of an integrated strategy for B. umbellatus control.
Sepsis – syndrome of infection complicated by organ dysfunction – is responsible for over 750 000 hospitalisations and 200 000 deaths in the USA annually. Despite potential nutritional benefits, the association of diet and sepsis is unknown. Therefore, we sought to determine the association between adherence to a Mediterranean-style diet (Med-style diet) and long-term risk of sepsis in the REasons for Geographic Differences in Stroke (REGARDS) cohort. We analysed data from REGARDS, a population-based cohort of 30 239 community-dwelling adults age ≥45 years. We determined dietary patterns from a baseline FFQ. We defined Med-style diet as a high consumption of fruit, vegetables, legumes, fish, cereal and low consumption of meat, dairy products, fat and alcohol categorising participants into Med-style diet tertiles (low: 0–3, moderate: 4–5, high: 6–9). We defined sepsis events as hospital admission for serious infection and at least two systematic inflammatory response syndrome criteria. We used Cox proportional hazard models to determine the association between Med-style diet tertiles and first sepsis events, adjusting for socio-demographics, lifestyle factors, and co-morbidities. We included 21 256 participants with complete dietary data. Dietary patterns were: low Med-style diet 32·0 %, moderate Med-style diet 42·1 % and high Med-style diet 26·0 %. There were 1109 (5·2 %) first sepsis events. High Med-style diet was independently associated with sepsis risk; low Med-style diet referent, moderate Med-style diet adjusted hazard ratio (HR) 0·93 (95 % CI 0·81, 1·08), high Med-style diet adjusted HR=0·74 (95 % CI 0·61, 0·88). High Med-style diet adherence is associated with lower risk of sepsis. Dietary modification may potentially provide an option for reducing sepsis risk.
Pseudorutile, , has recently been revalidated as a mineral species, and the neotype locality is now South Neptune Island, South Australia. Powder X-ray diffraction data are given on a hexagonal primitive unit cell with a = 2.8667(5) and c = 4.5985(9) Å. Leucoxene, arizonite and proarizonite are considered to be mixtures. Kleberite is considered to be a hydroxylian pseudorutile, .