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Problems in applying the analysis of variance are discussed. Emphasis is placed on using the technique to understand the data. The scale of the dependent variable is important for the analysis. Crossed and nested categories must be recognized. The error terms in the analysis depend on whether the classes of each independent variable are (1) all out of a few or (2) a few out of many. To simplify the analysis, mean squares should be aggregated with their error term when they are less than twice its size. An illustrative example is discussed in detail.
The prenatal and early-life periods pose a crucial neurodevelopmental window whereby disruptions to the intestinal microbiota and the developing brain may have adverse impacts. As antibiotics affect the human intestinal microbiome, it follows that early-life antibiotic exposure may be associated with later-life psychiatric or neurocognitive outcomes.
Aims
To explore the association between early-life (in utero and early childhood (age 0–2 years)) antibiotic exposure and the subsequent risk of psychiatric and neurocognitive outcomes.
Method
A search was conducted using Medline, PsychINFO and Excerpta Medica databases on 20 November 2023. Risk of bias was assessed using the Newcastle-Ottawa scale, and certainty was assessed using the grading of recommendations, assessment, development and evaluation (GRADE) certainty assessment.
Results
Thirty studies were included (n = 7 047 853 participants). Associations were observed between in utero antibiotic exposure and later development of autism spectrum disorder (ASD) (odds ratio 1.09, 95% CI: 1.02–1.16) and attention-deficit hyperactivity disorder (ADHD) (odds ratio 1.19, 95% CI: 1.11–1.27) and early-childhood exposure and later development of ASD (odds ratio 1.19, 95% CI: 1.01–1.40), ADHD (odds ratio 1.33, 95% CI: 1.20–1.48) and major depressive disorder (MDD) (odds ratio 1.29, 95% CI: 1.04–1.60). However, studies that used sibling control groups showed no significant association between early-life exposure and ASD or ADHD. No studies in MDD used sibling controls. Using the GRADE certainty assessment, all meta-analyses but one were rated very low certainty, largely owing to methodological and statistical heterogeneity.
Conclusions
While there was weak evidence for associations between antibiotic use in early-life and later neurodevelopmental outcomes, these were attenuated in sibling-controlled subgroup analyses. Thus, associations may be explained by genetic and familial confounding, and studies failing to utilise sibling-control groups must be interpreted with caution. PROSPERO ID: CRD42022304128
Illness and mortality have social origins, and infants and children are especially susceptible to the impacts of adverse social experiences. Early-life stress (ELS) – physiological disruptions suffered by a developing organism – is incorporated into human biology through embodiment. This paper examines whether children who lived and died in New Mexico (2011–2019) embodied social determinants of health. Data were collected from 780 postmortem computed tomography scans in conjunction with data from field notes and autopsy reports for individuals aged 0.5–20.99 years from New Mexico. Variables included in linear/logistic regressions are the per cent of families in poverty by ZIP code and year, housing type (trailer/mobile home, apartment, house), rural/urban residence areas, and race/ethnicity. Health outcome variables are age at death, respiratory conditions, growth stunting and arrest, and porous cranial lesions. Intersections of poverty, housing disparities, and race/ethnicity are examined to understand whether children from New Mexico incorporated ELS into their biology.
Results
Hispanic children have higher odds of growth stunting than non-Hispanic White children. Native American children die younger and have higher odds of respiratory diseases and porous lesions than Hispanic and non-Hispanic Whites. Rural/urban location does not significantly impact age at death, but housing type does. Individuals who lived in trailers/mobile homes had earlier ages at death. When intersections between housing type and housing location are considered, children who were poor and from impoverished areas lived longer than those who were poor from relatively well-off areas.
Conclusions
Children’s health is shaped by factors outside their control. The children included in this study embodied experiences of social and ELS and did not survive to adulthood. They provide the most sobering example of the harm that social factors (structural racism/discrimination, socioeconomic, and political structures) can inflict.
A clinical decision support system, EvalMpox, was developed to apply person under investigation (PUI) criteria for patients presenting with rash and to recommend testing for PUIs. Of 668 patients evaluated, an EvalMpox recommendation for testing had a positive predictive value of 35% and a negative predictive value of 99% for a positive mpox test.
This paper reports results from the eighth of a series of road transect surveys of Gyps vultures conducted across northern, central, western, and north-eastern India since the early 1990s. Populations of the White-rumped Vulture Gyps bengalensis, Indian Vulture G. indicus, and Slender-billed Vulture G. tenuirostris declined rapidly, beginning in the mid-1990s. The principal cause of the declines was poisoning due to widespread veterinary use of the non-steroidal anti-inflammatory drug (NSAID) diclofenac on cattle. The results of the current survey suggest that, while populations of all three species of vulture remain at a low level with no signs of recovery, they appear to have been approximately stable since veterinary use of diclofenac was banned in the mid-2000s. Population trends in India, where the illegal use of diclofenac and legal use of other toxic NSAIDs continues, are compared with more positive trends in Nepal, where the veterinary use of toxic NSAIDs appears to have been reduced to a low level.
The extremely toxic protein, ricin, is derived from castor beans and is a potential terrorist weapon. Adsorption to clays might minimize the environmental persistence and toxic effects of this toxin. Ricin adsorption to clay minerals was measured using batch adsorption isotherms. Enzyme-linked immunoassay methods were used to quantify aqueous ricin concentrations. Montmorillonite, sepiolite and palygorskite effectively adsorbed ricin from aqueous solutions and yielded mostly Langmuir-type isotherms. The monolayer adsorption capacity from a Langmuir equation fit at pH 7 was 444 g ricin/kg for montmorillonite (SWy-2), but was only 5.6 g ricin/kg for kaolinite (KGa-1b). Monolayer capacities for sepiolite (SepSp-1) and palygorskite (PFl-1) at pH 7 were 59.2 and 58.1 g ricin/kg. The high-charge montmorillonite (SAz-1) effectively adsorbed ricin at pH 7, but yielded a linear isotherm with K = 5530 L/kg. At pH 5, both montmorillonites (SWy-2 and SAz-1) yielded Langmuir-type isotherms with monolayer capacities of 694 and 641 g ricin/kg. Clay samples with higher cation exchange capacities generally adsorbed more ricin, but adsorption also followed specific surface area. X-ray diffraction of <2 μm SWy-2 treated with 470 g ricin/kg indicated expansion up to 34.6 Å at buffered pHs of 4 and 7, but not at pH 10. Furthermore, ricin adsorption was greatest at pH 4 and 7, but minimal at pH 10. Treatment with 1.41 kg of purified ricin/kg clay at pH 5 yielded a 35.3 Å peak and adsorption of ~1.2 kg ricin/kg. Similar treatment with lower-purity ricin yielded less expansion and lower adsorption. The 35.3 Å peak interpreted either as a d002 or d001 reflection indicates a 70.6 Å or a 35.3 Å ricin/SWy-2 complex. This implies that adsorption and air drying have compressed interlayer ricin molecules by 18 to 65%. Effective ricin adsorption by montmorillonite suggests that it could be used to minimize the toxic effects of dispersed ricin.
Bacterial superinfection and antibiotic prescribing in the setting of the current mpox outbreak are not well described in the literature. This retrospective observational study revealed low prevalence (11%) of outpatient antibiotic prescribing for bacterial superinfection of mpox lesions; at least 3 prescriptions (23%) were unnecessary.
Studies on predictors of outcomes of treatment for common mental health disorders (CMDs) in community mental health settings are scarce, and sample sizes are often small. Research on the impact of identifying as a member of an ethnic minority group on treatment outcomes is limited.
Aims:
To ascertain whether ethnicity is an independent predictor of outcome and the extent to which any association is mediated by other sociodemographic factors.
Method:
Retrospective observational study of anonymised treatment data collected for routine clinical purposes. Data were analysed from nine Improving Access to Psychological Therapy (IAPT) services from 2009 to 2016. Social functioning, ethnic group, age, gender, occupation and baseline severity of the mental health disorder were analysed as predictors of outcome.
Results:
Outcomes varied with ethnic group. Levels of occupation, social deprivation, initial morbidity and social functioning varied between ethnic groups at baseline. After adjustment for these factors the impact of ethnicity was attenuated and only some ethnic groups remained as significant independent predictors of treatment outcome.
Conclusions:
Ethnic minority status is a marker for multiple disadvantages. Some of the differences in outcome seen between ethnic groups may be the result of more general factors present in all ethnic groups but at greater intensity in some ethnic minority groups.
Siegfried Sassoon and Edmund Blunden both saw action and survived into the late twentieth century as successful men of letters whose styles were quite different. This chapter looks at their literary friendship and compares their work, clarifying where they stand in relation to the Georgians and other war poets, while putting them in a broader cultural perspective. It shows how experience of the trenches led them to twist traditional forms, and examines the stylistic and personal challenges they faced as survivors, their writings ever more retrospective. It argues that Blunden’s complexpoetry may feel archaic but has Modernist elements and has been unjustly neglected by comparison with Sassoon’s more accessible but less subtle verse. With close analysis and comparison, and some redefining of key texts, the chapter emphasises their contrasting approaches: Blunden the troubled pastoralist, exploring profounder shades of meaning; Sassoon deliberately ‘anti-poetic’, but with satirical designs on us.
Over the past two decades temporary agency work has increased in relation to most sectors and countries. This growth reflects the internationalisation of the agency business which, arguably, has come about due to demands for an ‘on-call just-in-time’ workforce. While temporary agency work possesses several conceptual and empirical challenges for researchers, it also poses challenges for regulators. This paper considers some of those challenges concerning various definitions, classifications and measurement of temporary work while comparing the Australian and Irish experience. It is concluded that while agency work in Australia and Ireland is modest, it is growing, and the conceptual and empirical problems associated with its under-recording pose difficulties for the design and implementation of a regulatory code for this sector.
This article compares the productivity and employment performance of the Australian and Irish economies over the 1990s, with particular emphasis on the different approaches to the role of information and communications technologies (ICT). Whereas Australia’s performance is characterised by the application and diffusion of ICT across a number of sectors, with indirect productivity and employment effects, Ireland has become a major producer of ICT products and services in its own right. The article traces the implications of these approaches for the pattern of growth and employment in both economies and also indicates their limitations. Ireland’s approach is limited by dependence on foreign investment, embodying externally generated technologies, though this is now being addressed by a policy interest in R&D support and the development of industry clusters and networks. On the other hand, Australia faces growing and possibly unsustainable deficits in its current account, driven by imports of knowledge-intensive goods and services, notwithstanding recent improvements in the terms of trade associated with higher prices for primary commodity exports.
On the Colombian Left during the 1940s, little differentiated the rank and file of the Communist party from the left wing of the Liberal party. Individuals commonly moved back and forth between the two groups. Animosity was rampant among leaders, however, as shown by the clashes between the principal compañeros and Jorge Eliécer Gaitán's left-Liberal populist mobilization. As this rivalry played out in the Communist strongholds of the union movement, it became apparent that a large portion of the organized working class (perhaps a majority) supported Gaitán even though their leaders dismissed him as a fascist. Workers, organized and unorganized, clearly demonstrated their belief that Gaitanismo was a radical movement of change despite the fact that it arose within the traditional party system.
Negative emotionality (NE) was evaluated as a candidate mechanism linking prenatal maternal affective symptoms and offspring internalizing problems during the preschool/early school age period. The participants were 335 mother–infant dyads from the Maternal Adversity, Vulnerability and Neurodevelopment project. A Confirmatory Bifactor Analysis (CFA) based on self-report measures of prenatal depression and pregnancy-specific anxiety generated a general factor representing overlapping symptoms of prenatal maternal psychopathology and four distinct symptom factors representing pregnancy-specific anxiety, negative affect, anhedonia and somatization. NE was rated by the mother at 18 and 36 months. CFA based on measures of father, mother, child-rated measures and a semistructured interview generated a general internalizing factor representing overlapping symptoms of child internalizing psychopathology accounting for the unique contribution of each informant. Path analyses revealed significant relationships among the general maternal affective psychopathology, the pregnancy- specific anxiety, and the child internalizing factors. Child NE mediated only the relationship between pregnancy-specific anxiety and the child internalizing factors. We highlighted the conditions in which prenatal maternal affective symptoms predicts child internalizing problems emerging early in development, including consideration of different mechanistic pathways for different maternal prenatal symptom presentations and child temperament.
Accompanied Voices is a unique book: not only is it a highly readable anthology of some of the most memorable and accessible international writing about classical music, and a moving commentaryby one set of practising artists on the work of another. There have been several anthologies of 'music poems', but never one which follows the story of western music through from the Renaissance tothe twenty-first century. This is in effect a chronological guide to the major composers of the last four hundred years, written in the language which comes closest to music itself - poetry.
Readers will find in Accompanied Voices the same pleasure that they might find in simply putting on a CD and listening. Every page brings something to arrest or transport and there is extraordinary diversity of response. Anecdote, epiphany, portrait, meditation... but many of these poets offer intellectual insights too and even critiques - there is far more variety here than any straightforward music essay can manage. These poems move beyond the mere names of composers and their works, reaching for more universal concerns.
Major poets represented include Geoffrey Hill,Ted Hughes, Elizabeth Jennings, Michael Longley, Andrew Motion, Peter Porter, Siegfried Sassoon, Jo Shapcott, Anne Stevenson and Charles Tomlinson among a total of nearly a hundred writers. JOHN GREENING is a poet and received a Cholmondeley Award in 2008. He is also a Hawthornden Fellow and a Fellow of the English Association. He has published studies of the Poets of the First World War,Yeats, Hardy, Edward Thomas and Elizabethan Love Poets.
There is global interest in the reconfiguration of community mental health services, including primary care, to improve clinical and cost effectiveness.
Aims
This study seeks to describe patterns of service use, continuity of care, health risks, physical healthcare monitoring and the balance between primary and secondary mental healthcare for people with severe mental illness in receipt of secondary mental healthcare in the UK.
Method
We conducted an epidemiological medical records review in three UK sites. We identified 297 cases randomly selected from the three participating mental health services. Data were manually extracted from electronic patient medical records from both secondary and primary care, for a 2-year period (2012–2014). Continuous data were summarised by mean and s.d. or median and interquartile range (IQR). Categorical data were summarised as percentages.
Results
The majority of care was from secondary care practitioners: of the 18 210 direct contacts recorded, 76% were from secondary care (median, 36.5; IQR, 14–68) and 24% were from primary care (median, 10; IQR, 5–20). There was evidence of poor longitudinal continuity: in primary care, 31% of people had poor longitudinal continuity (Modified Modified Continuity Index ≤0.5), and 43% had a single named care coordinator in secondary care services over the 2 years.
Conclusions
The study indicates scope for improvement in supporting mental health service delivery in primary care. Greater knowledge of how care is organised presents an opportunity to ensure some rebalancing of the care that all people with severe mental illness receive, when they need it. A future publication will examine differences between the three sites that participated in this study.
American society is rapidly secularizing–a radical departure from its historically high level of religiosity–and politics is a big part of the reason. Just as, forty years ago, the Religious Right arose as a new political movement, today secularism is gaining traction as a distinct and politically energized identity. This book examines the political causes and political consequences of this secular surge, drawing on a wealth of original data. The authors show that secular identity is in part a reaction to the Religious Right. However, while the political impact of secularism is profound, there may not yet be a Secular Left to counterbalance the Religious Right. Secularism has introduced new tensions within the Democratic Party while adding oxygen to political polarization between Democrats and Republicans. Still there may be opportunities to reach common ground if politicians seek to forge coalitions that encompass both secular and religious Americans.