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In April 2023, the Office of Management and Budget (OMB) published a draft of revisions to Circular A-4, the first changes proposed since its publication in 2003. Following a public comment period, OMB published the final revised Circular A-4 in November 2023. In this article, we provide a section-by-section comparison describing the similarities and differences between the April draft and the November revision of Circular A-4. Among other observations, we note that the revised Circular A-4 changes the default social rate of time preference from 1.7 to 2.0%, retains recommendations for using distributional weighting in benefit–cost analysis, and retains recommendations to use a global point of view when determining the spatial scope of the analysis.
Celiac disease (CD), an autoimmune disorder triggered by gluten, impacts about one percent of the population. Only one-third receive a diagnosis, leaving the majority unaware of their condition. Untreated CD can lead to gut lining damage, resulting in malnutrition, anemia, and osteoporosis. Our primary goal was to identify at-risk groups and assess the cost-effectiveness of active case finding in primary care.
Methods
Our methodology involved systematic reviews and meta-analyses focusing on the accuracy of CD risk factors (chronic conditions and symptoms) and diagnostic tests (serological and genetic). Prediction models, based on identified risk factors, were developed for identifying individuals who would benefit from CD testing in routine primary care. Additionally, an online survey gauged individuals’ preferences regarding diagnostic certainty before initiating a gluten-free diet. This information informed the development of economic models evaluating the cost-effectiveness of various active case finding strategies.
Results
Individuals with dermatitis herpetiformis, a family history of CD, migraine, anemia, type 1 diabetes, osteoporosis, or chronic liver disease showed one and a half to two times higher risk of having CD. IgA tTG, and EMA demonstrated good diagnostic accuracy. Genetic tests showed high sensitivity but low specificity. Survey results indicated substantial variation in preference for certainty from a blood test before initiating a gluten-free diet. Cost-effectiveness analyses showed that, in adults, IgA tTG at a one percent pre-test probability (equivalent to population screening) was the most cost effective. For non-population screening strategies, IgA EMA plus HLA was most cost effective. There was substantial uncertainty in economic model results.
Conclusions
While population-based screening with IgA tTG appears the most cost effective in adults, decisions for implementation should not solely rely on economic analyses. Future research should explore whether population-based CD screening aligns with UK National Screening Committee criteria and requires a long-term randomized controlled trial of screening strategies.
Contrasting the well-described effects of early intervention (EI) services for youth-onset psychosis, the potential benefits of the intervention for adult-onset psychosis are uncertain. This paper aims to examine the effectiveness of EI on functioning and symptomatic improvement in adult-onset psychosis, and the optimal duration of the intervention.
Methods
360 psychosis patients aged 26–55 years were randomized to receive either standard care (SC, n = 120), or case management for two (2-year EI, n = 120) or 4 years (4-year EI, n = 120) in a 4-year rater-masked, parallel-group, superiority, randomized controlled trial of treatment effectiveness (Clinicaltrials.gov: NCT00919620). Primary (i.e. social and occupational functioning) and secondary outcomes (i.e. positive and negative symptoms, and quality of life) were assessed at baseline, 6-month, and yearly for 4 years.
Results
Compared with SC, patients with 4-year EI had better Role Functioning Scale (RFS) immediate [interaction estimate = 0.008, 95% confidence interval (CI) = 0.001–0.014, p = 0.02] and extended social network (interaction estimate = 0.011, 95% CI = 0.004–0.018, p = 0.003) scores. Specifically, these improvements were observed in the first 2 years. Compared with the 2-year EI group, the 4-year EI group had better RFS total (p = 0.01), immediate (p = 0.01), and extended social network (p = 0.05) scores at the fourth year. Meanwhile, the 4-year (p = 0.02) and 2-year EI (p = 0.004) group had less severe symptoms than the SC group at the first year.
Conclusions
Specialized EI treatment for psychosis patients aged 26–55 should be provided for at least the initial 2 years of illness. Further treatment up to 4 years confers little benefits in this age range over the course of the study.
Objectives: Suicidal ideation (SI) is highly prevalent in Iraq/Afghanistan-era veterans with a history of mild traumatic brain injury (mTBI), and multiple mTBIs impart even greater risk for poorer neuropsychological functioning and suicidality. However, little is known about the cognitive mechanisms that may confer increased risk of suicidality in this population. Thus, we examined relationships between neuropsychological functioning and suicidality and specifically whether lifetime mTBI burden would moderate relationships between cognitive functioning and suicidal ideation. Methods: Iraq/Afghanistan-era Veterans with a history of mTBI seeking outpatient services (N = 282) completed a clinical neuropsychological assessment and psychiatric and postconcussive symptom questionnaires. Results: Individuals who endorsed SI reported more severe post-traumatic stress disorder (PTSD), depression, and postconcussive symptoms and exhibited significantly worse memory performance compared to those who denied SI. Furthermore, mTBI burden interacted with both attention/processing speed and memory, such that poorer performance in these domains was associated with greater likelihood of SI in individuals with a history of three or more mTBIs. The pattern of results remained consistent when controlling for PTSD, depression, and postconcussive symptoms. Conclusions: Slowed processing speed and/or memory difficulties may make it challenging to access and use past experiences to solve current problems and imagine future outcomes, leading to increases in hopelessness and SI in veterans with three or more mTBIs. Results have the potential to better inform treatment decisions for veterans with history of multiple mTBIs. (JINS, 2019, 25, 79–89)
While our fascination with understanding the past is sufficient to warrant an increased focus on synthesis, solutions to important problems facing modern society require understandings based on data that only archaeology can provide. Yet, even as we use public monies to collect ever-greater amounts of data, modes of research that can stimulate emergent understandings of human behavior have lagged behind. Consequently, a substantial amount of archaeological inference remains at the level of the individual project. We can more effectively leverage these data and advance our understandings of the past in ways that contribute to solutions to contemporary problems if we adapt the model pioneered by the National Center for Ecological Analysis and Synthesis to foster synthetic collaborative research in archaeology. We propose the creation of the Coalition for Archaeological Synthesis coordinated through a U.S.-based National Center for Archaeological Synthesis. The coalition will be composed of established public and private organizations that provide essential scholarly, cultural heritage, computational, educational, and public engagement infrastructure. The center would seek and administer funding to support collaborative analysis and synthesis projects executed through coalition partners. This innovative structure will enable the discipline to address key challenges facing society through evidentially based, collaborative synthetic research.
It has been suggested that twinning may influence handedness through the effects of birth order, intra-uterine crowding and mirror imaging. The influence of these effects on handedness (for writing and throwing) was examined in 3657 Monozygotic (MZ) and 3762 Dizygotic (DZ) twin pairs (born 1893–1992). Maximum likelihood analyses revealed no effects of birth order on the incidence of left-handedness. Twins were no more likely to be left-handed than their singleton siblings (n = 1757), and there were no differences between the DZ co-twin and siblingtwin covariances, suggesting that neither intra-uterine crowding nor the experience of being a twin affects handedness. There was no evidence of mirror imaging; the co-twin correlations of monochorionic and dichorionic MZ twins did not differ. Univariate genetic analyses revealed common environmental factors to be the most parsimonious explanation of familial aggregation for the writing-hand measure, while additive genetic influences provided a better interpretation of the throwing hand data.
This paper examines the landscape context of the Bartlow Hills, a group of large Romano-British barrows that were excavated in the 1840s but have been largely neglected since. GIS is employed to test whether it was possible to view the mounds from nearby roads, barrows, and villas. Existing research on provincial barrows, and especially their landscape context, and some recent relevant applications of GIS are reviewed. We argue that barrows are active and symbolically charged statements about power and identity. The most striking pattern to emerge from the GIS analysis is a focus on display to a local rather than a transient audience.
An experiment to measure the variation in the phenological and apical development ofwinter wheat (cv. Avalon) in England and Scotland is described. Ten sites which ranged from Aberdeen (57·2° N), the most northerly, to Newton Abbot (50·6° N), the most southerly, were included in the survey, and at each site seed was hand-sown in mid-September, October and November 1983. Developmental stages and sampling procedures were precisely defined to ensure uniformity in scoring by the observers at each site. Temperatures during the growing season were in line with the long-term means, though spring was cooler at all sites and summer warmer at most. The range of monthly-mean temperatures between sites was about the same as the difference between consecutive months. The method of analysis of development rates and durations was in terms of thermal time, modified by sensitivity to photoperiod and a vernalization requirement that slowed early development until a number of days of low temperatures had been experienced. In general, crops at northern sites developed more slowly than those in the south and particularly the south-west of England. There was less variation in the timing of apical stages for later sowings. Developmental rates responded linearly to temperature and photoperiod, with the base temperature increasing for later phases of development. The effect of photoperiod in modifying the rate of development was apparent for all developmental phases from emergence to anthesis, longer days accelerating development, but there was no effect on the duration of the grain-filling period. Vernalization exerted its effect solely within the phase from emergence to double ridge, and had a major influence on the variation between sites only for the first sowing.
The initiation of leaf and spikelet primordia was studied at sites ranging in latitude from Newton Abbot (50·6°N) to Aberdeen (57·2°N) in crops sown in the middle of September, October and November 1983. The rate of primordium initiation tended to decrease from south to north but there were also marked differences between quite close sites.
The rate of leaf initiation increased with temperature but photoperiod had little effect; the rate of spikelet initiation was affected both by temperature and by photoperiod. There were differences in the total number of leaves initiated which were only partlyexplained by differences in vernalization.
Expressing leaf and spikelet initiation rates in terms of thermal and photo-thermal time respectively showed a constant rate of leaf initiation and a constant and more rapid rate of spikelet initiation.
This study examined the effects of lexical frequency on children's production of accurate primary stress in words derived with nonneutral English suffixes. Forty-four third-grade children participated in an elicited derived word task in which they produced high-frequency, low-frequency, and nonsense-derived words with stress-changing suffixes (i.e., -tion, -ic, -ity). Derived word frequency affected stress production accuracy; however, the individual suffix also played an important role in stress placement, with -tion productions more accurate than either -ic or -ity productions. For the real words, derived word frequency relative to stem frequency was related to performance. Stress was less accurate on derived words that were much lower in frequency than their stems (e.g., tranquil/tranquility) and more accurate on derived words that approximated or exceeded their stem frequency (e.g., motivate/motivation). In addition to derived word and stem frequency, results are discussed with reference to several phonological characteristics that may also influence stress production accuracy.
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