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.
Bipolar depression remains difficult to treat, and people often experience ongoing residual symptoms, decreased functioning and impaired quality of life. Adjunctive therapies targeting novel pathways can provide wider treatment options and improve clinical outcomes. Garcinia mangostana Linn. (mangosteen) pericarp has serotonogenic, antioxidant anti-inflammatory and neurogenic properties of relevance to the mechanisms of bipolar depression.
Aims
The current 28-week randomised, multisite, double-blind, placebo-controlled trial investigated mangosteen pericarp extract as an adjunct to treatment-as-usual for treatment of bipolar depression.
Method
This trial was prospectively registered on the Australia New Zealand Clinical Trials Registry (no. ACTRN12616000028404). Participants aged 18 years and older with a diagnosis of bipolar I or II and with at least moderate depressive symptoms were eligible for the study. A total of 1016 participants were initially approached or volunteered for the study, of whom 712 did not progress to screening, with an additional 152 screened out. Seventy participants were randomly allocated to mangosteen and 82 to a placebo control. Fifty participants in the mangosteen and 64 participants in the placebo condition completed the treatment period and were analysed.
Results
Results indicated limited support for the primary hypothesis of superior depression symptom reduction following 24 weeks of treatment. Although overall changes in depressive symptoms did not substantially differ between conditions over the course of the trial, we observed significantly greater improvements for the mangosteen condition at 24 weeks, compared with baseline, for mood symptoms, clinical impressions of bipolar severity and social functioning compared with controls. These differences were attenuated at week 28 post-discontinuation assessment.
Conclusions
Adjunctive mangosteen pericarp treatment appeared to have limited efficacy in mood and functional symptoms associated with bipolar disorder, but not with manic symptoms or quality of life, suggesting a novel therapeutic approach that should be verified by replication.
The CEOs of Britain's largest companies wield immense power, but we know very little about them. How did they get to the top? Why do they have so much power? Are they really worth that exorbitant salary? Michael Aldous and John Turner provide the answers by telling the story of the British CEO over the past century. From gentleman amateurs to professional managers, entrepreneurs, frauds, and fat cats, they reveal the characters who have made it to the top of the corporate ladder, how they got there, and what their rise tells us about British society. They show how the quality of their leadership influences productivity, innovation, economic development and, ultimately, Britain's place in the world. More recently, issues have arisen regarding high CEO pay, poor performance, and a lack of professionalisation and diversity. Are there lessons from history for those who would seek to reform Britain's flagging corporate economy?
Viscount Victor Spencer was representative of the British social elites deeply entrenched in business at the beginning of the twentieth century. He was amongst the 41 per cent of CEOs who were peers of the realm. Like most of these peers, he did not have a background in the business world or industry. This chapter details why these aristocratic amateurs initially dominated corporate leadership roles but rapidly declined in number as social and political changes reduced the importance of the aristocracy and the economic environment was transformed by the technological and business innovations of the second industrial revolution. They were replaced by professional managers like Thomas Sutherland of the shipping company P&O, founder CEOs such as Thomas Lipton, and family CEOs such as Archibald Coats of the textile business J & P Coats. These CEOs developed extensive business experience as insiders within their companies, which allowed them to innovate the strategy and structure of their companies. Despite their decline, the gentleman amateurs performed no worse than these players.
Across the twentieth century, CEOs became more powerful, and their decisions had a sizeable effect on their company’s performance and the British economy. Some CEOs harnessed technological and organisational innovations which allowed companies to grow and become more efficient, resulting in improvements in national productivity. In contrast, the insularity and lack of dynamism of some CEOs played a significant role in Britain’s economic stagnation. History shows that who gets to the top matters. Based on this, the chapter goes on to argue that those involved in selecting and preparing CEOs need to develop pathways to the top that identify individuals with interpersonal characteristics, values, and vision focused on the long-term stewardship of companies. They need to improve diversity to ensure that a range of cognitive abilities and insights get to the top. Across the century, various corporate governance mechanisms have been used to address the principal–agent problem at the heart of the corporation. The chapter closes by arguing that corporate governance needs to be strengthened through legislation to align CEOs to the long-term interests of company stakeholders.
By the 1970s, Britain’s economic malaise had become chronic. This chapter shows how a group of business outsiders sought to cure the malaise by unleashing market forces. These buccaneers, including Jim Slater, Jimmy Goldsmith, James Hanson, and Gordon White perfected the art of the hostile takeover to shake up poor-quality incumbent management. They believed they were liberating assets and improving the performance of management by focusing their attention on shareholder value. This resulted in high-profile and acrimonious takeover battles. Their critics named them corporate raiders, and incumbents such as Denys Henderson of ICI fought back through accusations of asset stripping and sweating. Although few tangible elements of the buccaneers’ empires survived their fall in the 1990s, they had a profound impact on business strategy, the role of the CEO, and the British economy. They empowered CEOs, their demands for improved corporate leadership were followed, and a growing number of CEOs were sacked for poor performance. Their business model influenced the growing financialisation of companies and Margaret Thatcher’s economic reforms.
Family and founder CEOs had their heyday in the interwar period. They faced a highly volatile economic and geopolitical environment. The chapter shows how they responded to these challenges. CEOs such as Alfred Mond led his family company to become the chemicals giant ICI, and William Lever founded and grew consumer goods company Lever Bros. Skin in the game and roots in social groups outside the mainstream of British society gave many of the families and founders a set of values and a deep commitment to grow their companies. Through investment and innovation, they achieved scale and scope. Their success took some to the heart of government, where they reshaped competition policy. The chapter then goes on to show that families and founders were particularly challenged by succession issues. John Ellerman, the most successful entrepreneur of the era, found his son had little interest in his business empire. The succession trap led to the collapse of many family companies. Others survived by handing power to professional managers such as D’Arcy Cooper, who transformed Lever Bros. Families and founders declined in importance, but through their stewardship corporate giants were built.
In the 1990s, privatisations, globalisation, and the ICT revolution opened up the British economy. This chapter examines how CEOs took advantage of these opportunities. Privatisation of national industries meant CEOs such as George Jefferson of BT now led some of Britain’s largest companies. Jefferson and his successors ensured their pay increased significantly. The average pay of CEOs rose rapidly, becoming a fixture of media debates, making the likes of Cedric Brown of British Gas a cause célébre. British CEOs finally underwent a managerial revolution in terms of education levels and training, but did increased pay correspond with improved corporate performance? In banking, pay rose for the likes of Fred Goodwin of RBS, and James Crosby and Andy Hornby of HBOS. But these CEOs all played leading roles in the collapse of their banks in 2008. The chapter shows how the Cadbury Report sought to rein in CEO excesses, but with limited effect. Governance problems were exacerbated as CEOs got younger and their tenures shorter, further incentivising short-term thinking. Women finally entered the role of CEO with Marjorie Scardino of Pearson and Cynthia Carroll at Anglo American.
This chapter sets out the debates that have grown up around CEOs, highlighting three major reasons why they warrant serious study: their importance to the companies they lead, their wider economic and political power, and what their careers tell us about social mobility. To address these debates the book explores three questions: Who were the CEOs and how did they get into the role? What did they do? Did they matter for their companies and Britain’s economy and society? To answer these questions, a unique database of the CEOs of the top 100 most valuable UK public companies between 1900 and 2009 has been assembled. This consists of 475 companies and 1,397 CEOs. For each CEO a career biography is created. To analyse the data, we draw on Upper Echelons Theory and Agency Theory, alongside historical scholarship to understand the environments in which they operated. The chapter then sets out the five analytical threads that are developed throughout the book. The chapter closes by discussing how the nomenclature around top corporate officers evolved from ‘chairman’ to ‘managing director’ to ‘chief executive officer’.
After World War II, Britain’s CEOs faced major economic challenges. International competition increased, and Harold Wilson called for a managerial revolution to exploit the white heat of new technology. This chapter examines whether this revolution occurred. Engineers, including Leonard Lord and George Harriman of the British Motor Corporation, and accountants, like John Davis of Rank and Leslie Lazell of Beechams, made up an increasing proportion of top CEOs. These trends increased social diversity with over 70 per cent of CEOs rising through merit rather than social position or family. Yet, British CEOs had significantly less formal education and specialist management training than their competitors. In 1950, 36 per cent of British CEOs had an undergraduate degree. The equivalent figures were 75, 75, and 95 per cent in the United States, Germany, and France. Although training in accountancy and engineering brought a focus on optimisation and efficiency, it lacked more holistic approaches to management, resulting in bureaucratic organisations and siloed thinking. The managerial revolution failed, innovation and productivity suffered, and economic malaise set in.
Successfully educating urgent care patients on appropriate use and risks of antibiotics can be challenging. We assessed the conscious and subconscious impact various educational materials (informational handout, priming poster, and commitment poster) had on urgent care patients’ knowledge and expectations regarding antibiotics.
Design:
Stratified Block Randomized Control Trial.
Setting:
Urgent care centers (UCCs) in Colorado, Florida, Georgia, and New Jersey.
Participants:
Urgent care patients.
Methods:
We randomized 29 UCCs across six study arms to display specific educational materials (informational handout, priming poster, and commitment poster). The primary intention-to-treat (ITT) analysis evaluated whether the materials impacted patient knowledge or expectations of antibiotic prescribing by assigned study arm. The secondary as-treated analysis evaluated the same outcome comparing patients who recalled seeing the assigned educational material and patients who either did not recall seeing an assigned material or were in the control arm.
Results:
Twenty-seven centers returned 2,919 questionnaires across six study arms. Only 27.2% of participants in the intervention arms recalled seeing any educational materials. In our primary ITT analysis, no difference in knowledge or expectations of antibiotic prescribing was noted between groups. However, in the as-treated analysis, the handout and commitment poster were associated with higher antibiotic knowledge scores.
Conclusions:
Educational materials in UCCs are associated with increased antibiotic-related knowledge among patients when they are seen and recalled; however, most patients do not recall passively displayed materials. More emphasis should be placed on creating and drawing attention to memorable patient educational materials.
People with type 2 diabetes (T2D) are more likely to experience binge eating than the general population, which may interfere with their diabetes management. Guided self-help (GSH) is one of the recommended treatment options for binge eating disorder, but there is currently a lack of evidenced treatment for binge eating in individuals living with T2D. The aims of this pilot study were to test the feasibility and acceptability of recruiting and delivering the adapted, online Working to Overcome Eating Difficulties GSH intervention to adults with T2D and binge eating. The intervention comprises GSH materials presented online in seven sections delivered over 12 weeks, supported by a trained Guide. Twenty-two participants were recruited in a case series design to receive the intervention and we interviewed four Guides and five participants afterwards. We measured binge eating, mental wellbeing, quality of life and weight at pre-post and 12-week follow-up. Results showed a significant reduction in binge eating at the end of the intervention, which continued to improve at follow-up. Before the programme, 92 % of participants scored above cut-off for binge eating. This reduced to 41 % post-intervention and no-one at follow-up. These changes were accompanied by significant improvements in depression, anxiety and small changes in eating disorder symptoms. Participants reported making better lifestyle choices, eating more mindfully and having increased self-confidence. The study shows preliminary evidence for online GSH tailored to the needs of individuals with T2D as a feasible and acceptable approach to improving binge eating, diabetes management and mental wellbeing.
This survey of 66 specialist mental health services aimed to provide an up-to-date description of pathways of care and interventions available to children with an intellectual disability referred for behaviours that challenge or with suspected mental health problems.
Results
Overall, 24% of services made contact with a family at referral stage, whereas 29% contacted families at least once during the waiting list phase. Only two in ten services offered any therapeutic input during the referral or waiting list stages. During the active caseload phase, services offered mostly psychoeducation (52–59%), followed by applied behaviour analytic approaches for behaviours that challenge (52%) and cognitive–behavioural therapy (41%). Thirty-six per cent of services had not offered any packaged or named intervention in the past 12 months.
Clinical implications
With increasing waiting times for specialist mental health support, services need to consider increasing the amount of contact and therapeutic input on offer throughout all stages of a child's journey with the service.