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.
Governments and regulatory agencies make policy through a range of instruments from soft-law guidelines and executive orders to executive rules with the force of law. Based on her book, Democracy and Executive Power, Susan Rose-Ackerman’s essay highlights the link between cross-country differences in rulemaking practices and underlying constitutional frameworks. Based on the US, the UK, Germany, and France, the chapter illustrates how these countries’ disparate constitutional structures help to explain their divergent rulemaking practices. She stresses the existence of policymaking accountability under the rulemaking provisions of the US APA and its absence from the other cases. Nevertheless, whatever the legal framework, the author argues that bureaucrats should take account of outside input as they implement statutory language to make policy choices. The organization of the executive branch should encourage public input and promote bureaucratic competence. Contemporary pressures may indeed be moving all of these countries toward more accountable procedures – not just to protect individual rights but also to enhance the democratic legitimacy of executive rulemaking.
Objectives/Goals: We aim to explore the associations of race/ethnicity and socioeconomic status (SES): 1) with grip strength, walking speed, and comorbidity index cross-sectionally and 2) with the change in comorbidity index and mortality risk over four years of follow-up in cancer survivors. Both aims will examine the potential mediating role of cytomegalovirus (CMV) infection. Methods/Study Population: This study includes 1,602 cancer survivors (mean age = 72 years, 10% Black, 54% female) from the Health and Retirement Study (HRS), a nationally representative U.S. sample followed for health outcomes until 2020. HRS measured CMV immunoglobulin G (IgG) antibody levels (from blood samples), grip strength, and walking speed in 2016. We will apply linear regression to examine the associations of race/ethnicity and SES with grip strength, walking speed, and comorbidity index cross-sectionally and with the change in comorbidity index over four years of follow-up. We will apply Cox proportional hazard regression to examine the associations of race/ethnicity and SES with mortality over four years of follow-up. In all models, we will investigate the potential mediating role of CMV infection in these associations. Results/Anticipated Results: We expect that CMV infection mediates the associations of race/ethnicity and SES with age-related health outcomes, including muscle weakness (measured by grip strength), decreased functional performance (measured by walking speed), comorbidity index, and mortality in elderly cancer survivors. Discussion/Significance of Impact: If our hypothesis is confirmed, the findings may inform physicians to closely monitor CMV infection among cancer survivors from socially disadvantaged groups and apply treatment if needed. Several oral medications for CMV exist, and CMV vaccines are currently undergoing testing in clinical trials. This will make the treatment for CMV more accessible.
Anxiety affects around one in five women during pregnancy and after birth. However, there is no systematic information on the proportion of women with perinatal anxiety disorders who want or receive treatment.
Aims
To examine (a) the prevalence of anxiety disorders during pregnancy and after birth in a population-based sample, and (b) the proportion of women with anxiety disorders who want treatment and receive treatment.
Method
This study conducted 403 diagnostic interviews in early pregnancy (n = 102), mid-pregnancy (n = 99), late pregnancy (n = 102) or postpartum (n = 100). Participants also completed self-report measures of previous/current mental health problems and desire for treatment at every time point.
Results
The prevalence of anxiety disorders over all time points combined was 19.9% (95% CI 16.1–24.1), with greatest prevalence in early pregnancy (25.5%, 95% CI 17.4–35.1). The most prevalent disorders were obsessive–compulsive disorder (8.2%, 95% CI 5.7–11.3) and generalised anxiety disorder (5.7%, 95% CI 3.7–8.4). The majority of women with anxiety disorders did not want professional help or treatment (79.8%). Most women with anxiety disorders who did want treatment (20.2%) were receiving treatment. The majority of participants with anxiety disorders had a history of mental health problems (64.6%).
Conclusions
Prevalence rates overall are consistent with previous research, lending validity to the findings. However, findings challenge the assumption that everyone with a psychological disorder wants treatment. These findings highlight the importance of relationship-based care, where individual needs and contextual barriers to treatment can be explored.
Like its immediate predecessor, this seventh Naval Miscellany clearly reveals how wide ranging and varied were the responsibilities of British seamen in the service of the Crown. The period covered extends from the late thirteenth century, when there was nothing in existence which could truly be called a navy, to the second half of the twentieth century when the Royal Navy faced all manner of new challenges, including the possibility of nuclear war.
Contributions dealing with the earliest periods are concerned only with what are now thought of as home waters [I and II both dealing with campaigns against Scotland]. We move on to voyages to Iceland [III], in the Baltic [IV], and thereafter to the high seas in general. Even more than the ever wider geographical spread of Naval activity, the topics covered show how deeply maritime affairs became woven into British life in time of peace as well as war. The ships of the Cinque Ports and the other harbours along the south and east coasts of England which transported Edward I's armies and their victuals and equipment to Scotland [I] were everyday merchantmen, many no larger than a modern yacht. Without their help the King's ambitious campaigns would have foundered. The documents printed also shed light on the shipping of the period, its design and construction and the number of vessels which could be pressed into royal service. Changes by the sixteenth century are made clear by comparing this contribution with that relating to Lord Lisle's expedition of 1544 [II]. The log of the voyage of the Marigold [III] just over a century later says much about contemporary seamanship and the way in which governments by then saw the fisheries as one of their legitimate concerns.
The voyages of the Raven and the Investigator [VI, VII] not only indicate the professionalism of the surveying and chart-making activities of the Hydrographic Office but also the value of those activities for the economic development of the areas concerned. The difficulties of organising such expeditions in areas little known at the time are vividly portrayed. However, the largest group of contributions is concerned with various aspects of the Royal Navy as a fighting force in the defence of the realm.
Two separate accounts have been transcribed and translated here. Both are preserved in The National Archives at Kew and come from the records of the Exchequer. Both date from the reign of Edward III and relate to the affairs of Thomas de Snetesham who was Clerk of the King's Ships in the early years of this office. He was first appointed in 1336 but at times shared the title and the duties of the office with William de Clewere and Matthew de Torksey whose accounts at times cover periods overlapping with those of Snetesham. Similarly towards the end of the reign of Edward III the office seems to have been shared to some extent between Robert Crull and John de Haytfield.
The duties of the office seem not to have been clearly defined until the end of the century with each clerk having a slightly different set of responsibilities. Generally, the duties of the Clerk of the King's Ships extended to the repair of royal ships, sometimes to the building of a new one, the provision of supplies like cordage and caulking materials and occasionally victuals, and the organisation of ship keepers to care for the vessels when they were in harbour or laid up in an anchorage. The Clerks were not concerned with operational matters although some mention is often made of the voyages for which a vessel was being prepared. A particular value of these accounts is to allow some conclusions to be drawn about the ships themselves, their design and their equipment. They also allow us to understand how a medieval monarchy approached the expensive and onerous task of keeping a royal fleet in a seaworthy condition and the way in which this had become of much greater concern than previously in the reign of Edward III.
The first account edited comes from the Accounts Various class of the Exchequer (TNA E101) and consists of the particulars of account kept by Snetesham for the year 18 Edward III, that is 25 January 1344–25 January 1345. He is described as Clerk of the ship George, not as Clerk of the King's Ships in this particular instance. From the account it is not clear whether this refers to the ship called George , formerly in French ownership, which was captured at the battle of Sluys by the English and which sank in Winchelsea harbour in 1346.
Froissart's vivid descriptions of the discomforts of campaigning in Scotland and the absolute necessity of ensuring that the armies were properly supplied with victuals and all the other things needed provide the background to Edward I's concern with using the Naval resources of his kingdom to supply his forces in Scotland. In 1327 Froissart wrote:
the men had to sleep in full armour, holding their horses by the bridles since they had nothing to tie them to, having left their equipment on the carts which could not follow them over such country. For the same reason there were no oats or other fodder to give the horses and they themselves had nothing to eat all that day and night except the loaves which they had tied behind their saddles and these were all soiled and sodden with the horses’ sweat. They had nothing to drink but the water of the river … they had no lights or fire and no means of kindling them.
In 1298, at the siege of Falkirk, the English army had almost starved for lack of supplies; clearly an army could not expect to live off the country in Scotland but must rely on all supplies being brought up from the south with transport by water being the most practical method.
The documents printed here illustrate two aspects of the need to provide shipping to support campaigns in Scotland in the later years of Edward I's reign. First there are four accounts which give details of the building of vessels, usually called barges, for the king [1–4], and secondly there is a selection of writs and accounts which provide examples of the way in which shipping was arrested by the Crown for these campaigns and the kind of problems which could arise [5–7]. All the documents come from the class of Exchequer Accounts Various (E101) at the National Archives at Kew.
Edward I had become involved in the affairs of Scotland after the death of Alexander III in a riding accident in 1286, leaving no direct heir except a young girl, Margaret, the Maid of Norway, his granddaughter. Her mother, also Margaret, who had been sent from Scotland to Norway to marry King Eric II, had died, probably in childbirth, leaving this little daughter as the only surviving direct descendant of Alexander, whose two sons had predeceased him.
Anxiety in pregnancy and after giving birth (the perinatal period) is highly prevalent but under-recognised. Robust methods of assessing perinatal anxiety are essential for services to identify and treat women appropriately.
Aims
To determine which assessment measures are most psychometrically robust and effective at identifying women with perinatal anxiety (primary objective) and depression (secondary objective).
Method
We conducted a prospective longitudinal cohort study of 2243 women who completed five measures of anxiety and depression (Generalized Anxiety Disorder scale (GAD) two- and seven-item versions; Whooley questions; Clinical Outcomes in Routine Evaluation (CORE-10); and Stirling Antenatal Anxiety Scale (SAAS)) during pregnancy (15 weeks, 22 weeks and 31 weeks) and after birth (6 weeks). To assess diagnostic accuracy a sample of 403 participants completed modules of the Mini-International Neuropsychiatric Interview (MINI).
Results
The best diagnostic accuracy for anxiety was shown by the CORE-10 and SAAS. The best diagnostic accuracy for depression was shown by the CORE-10, SAAS and Whooley questions, although the SAAS had lower specificity. The same cut-off scores for each measure were optimal for identifying anxiety or depression (SAAS ≥9; CORE-10 ≥9; Whooley ≥1). All measures were psychometrically robust, with good internal consistency, convergent validity and unidimensional factor structure.
Conclusions
This study identified robust and effective methods of assessing perinatal anxiety and depression. We recommend using the CORE-10 or SAAS to assess perinatal anxiety and the CORE-10 or Whooley questions to assess depression. The GAD-2 and GAD-7 did not perform as well as other measures and optimal cut-offs were lower than currently recommended.
Perinatal mental health (PMH) problems are a leading cause of maternal death and increase the risk of poor outcomes for women and their families. It is therefore important to identify the barriers and facilitators to implementing and accessing PMH care.
Aims
To develop a conceptual framework of barriers and facilitators to PMH care to inform PMH services.
Method
Relevant literature was systematically identified, categorised and mapped onto the framework. The framework was then validated through evaluating confidence with the evidence base and feedback from stakeholders (women and families, health professionals, commissioners and policy makers).
Results
Barriers and facilitators to PMH care were identified at seven levels: individual (e.g. beliefs about mental illness), health professional (e.g. confidence addressing perinatal mental illness), interpersonal (e.g. relationship between women and health professionals), organisational (e.g. continuity of carer), commissioner (e.g. referral pathways), political (e.g. women's economic status) and societal (e.g. stigma). The MATRIx conceptual frameworks provide pictorial representations of 66 barriers and 39 facilitators to PMH care.
Conclusions
The MATRIx frameworks highlight the complex interplay of individual and system-level factors across different stages of the care pathway that influence women accessing PMH care and effective implementation of PMH services. Recommendations are made for health policy and practice. These include using the conceptual frameworks to inform comprehensive, strategic and evidence-based approaches to PMH care; ensuring care is easy to access and flexible; providing culturally sensitive care; adequate funding of services and quality training for health professionals, with protected time to complete it.