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.
Bupropion is not licensed as an antidepressant in the UK, limiting its use. We highlight bupropion’s distinct pharmacological profile and its potential benefits in treatment-resistant depression and people experiencing selective serotonin reuptake inhibitor-induced sexual dysfunction. The National Health Service repurposing medicines programme could improve equity of access for UK patients.
Average lifespans for people with physical disabilities are increasing; yet there is limited knowledge about their perceptions of what it means to age well. The criteria for Rowe and Kahn’s influential model of successful ageing effectively preclude people ageing with a long-term disability. Several authors have attempted to develop more-inclusive models of successful ageing. The aim of this study was to explore what successful ageing means for people ageing with either spinal cord injury (SCI) or post-polio syndrome (PPS). We used an emic-based methodology, and recruited from Australia 17 participants aged 40–78 years. Nine participants (one male, eight female) had acquired poliomyelitis in childhood and experienced PPS, and eight participants (seven male, one female) had acquired an SCI 15 or more years ago. We used semi-structured interviews to elicit participants’ views on the dimensions important to ageing successfully with a disability, and analysed the transcripts using inductive thematic analysis. We identified eight themes, which related to: (1) maintaining physical health, (2) retaining cognitive abilities, (3) a sense of safety and security, (4) being treated with fairness and respect, (5) positive psychological resources, (6) independence and autonomy, (7) social engagement and participation in community and (8) a sense of purpose. We used the findings to construct a multi-dimensional successful ageing model for those ageing with SCI or PPS. The model includes insights from lay perspectives that further illustrate the role broader society plays in supporting or hindering individuals to age successfully, and has implications for health-care and government services.
Preliminary evidence suggests that a ketogenic diet may be effective for bipolar disorder.
Aims
To assess the impact of a ketogenic diet in bipolar disorder on clinical, metabolic and magnetic resonance spectroscopy outcomes.
Method
Euthymic individuals with bipolar disorder (N = 27) were recruited to a 6- to 8-week single-arm open pilot study of a modified ketogenic diet. Clinical, metabolic and MRS measures were assessed before and after the intervention.
Results
Of 27 recruited participants, 26 began and 20 completed the ketogenic diet. For participants completing the intervention, mean body weight fell by 4.2 kg (P < 0.001), mean body mass index fell by 1.5 kg/m2 (P < 0.001) and mean systolic blood pressure fell by 7.4 mmHg (P < 0.041). The euthymic participants had average baseline and follow-up assessments consistent with them being in the euthymic range with no statistically significant changes in Affective Lability Scale-18, Beck Depression Inventory and Young Mania Rating Scale. In participants providing reliable daily ecological momentary assessment data (n = 14), there was a positive correlation between daily ketone levels and self-rated mood (r = 0.21, P < 0.001) and energy (r = 0.19 P < 0.001), and an inverse correlation between ketone levels and both impulsivity (r = −0.30, P < 0.001) and anxiety (r = −0.19, P < 0.001). From the MRS measurements, brain glutamate plus glutamine concentration decreased by 11.6% in the anterior cingulate cortex (P = 0.025) and fell by 13.6% in the posterior cingulate cortex (P = <0.001).
Conclusions
These findings suggest that a ketogenic diet may be clinically useful in bipolar disorder, for both mental health and metabolic outcomes. Replication and randomised controlled trials are now warranted.
Through compositional inclusion or exclusion, the photograph can assert and communicate what belongs in a picture, in a landscape, in an ecosystem. It can illuminate what we deem conservation-worthy, or, on a larger scale, which extinctions are attention-worthy. Photographic practice helps to illuminate the active nature of extinction, and our choices as actors and witnesses within that process. Here, researchers from the University of Leeds’ Extinction Studies Doctoral Training Programme present individual reflections on interdisciplinary practice-led research in the Scottish Small Isles. We consider how photography, as a form of praxis, can generate new forms of knowledge surrounding extinction: its meanings, representations, and legacies, particularly through visual representation. We offer seven perspectives on contemporary image-making, from disciplines including philosophy, conservation biology, literature, sociology, geology, cultural anthropology, and palaeontology. Researchers gathered experiential, ethical, even biological meanings from considering what to include or exclude in images: from the micro to the macro, the visible to the invisible, the aesthetic to the ecological. We draw conclusions around meaning-making through the process of photography itself, and the tensions encountered through framing and decision-making in a time of mass ecological decline.
MagNetUS is a network of scientists and research groups that coordinates and advocates for fundamental magnetized plasma research in the USA. Its primary goal is to bring together a broad community of researchers and the experimental and numerical tools they use in order to facilitate the sharing of ideas, resources and common tasks. Discussed here are the motivation and goals for this network and details of its formation, history and structure. An overview of associated experimental facilities and numerical projects is provided, along with examples of scientific topics investigated therein. Finally, a vision for the future of the organization is given.
The Constitution of Australia embodies a liberal political theory that the freedom of the citizen is dependent on the separation and distribution of the powers of the state between different institutions - legislative, executive and judicial. With the possible exception of a democratically elected legislature, none of these institutions should dominate the way in which the powers of the remainder are exercised. For the safeguard of personal liberty, each should act as a check and balance against the over-exercise of power by the remainder, and especially by the executive government of the day.
This principle - the separation of powers - was inherited originally from England but developed considerably in the United States. It has been regarded as a fundamental element of the Constitution since the act of federation in 1901. Recognition of the principle reputedly reached a high point in Boilermakers, a decision of the High Court of Australia in 1956.
Identifying feeding interactions in the fossil record remains a key challenge for paleoecologists. We report the rare occurrence of a conical, perforative bite mark in a cervical vertebra of an azhdarchid pterosaur, which we identified as a juvenile individual of Cryodrakon boreas Hone, Habib, and Therrien, 2019 from the Campanian Dinosaur Park Formation in Alberta, Canada. Based on comparative analysis of the dentition and ecomorphology of potential trace makers in the Dinosaur Park Formation, as well as the morphology of the trace, the most likely candidate is a crocodilian, although whether it was made as a result of scavenging or predatory behavior is unknown. Feeding interactions involving pterosaurs are rare globally, whereas crocodilian bite marks are not uncommon in Cretaceous terrestrial ecosystems. Given the opportunistic feeding style and known range of food items for both extant and extinct crocodilians, pterosaurs can be counted as a rare, but not surprising, component of at least some Cretaceous crocodilian diets.
Skin and soft tissue infections (SSTIs) account for over 2.8 million annual emergency department (ED) visits and often result in suboptimal antibiotic therapy. The objective of this study was to evaluate a set of interventions in minimizing inappropriate prescription of antibiotics for presumed SSTIs in the ED.
Design:
Case vignette survey.
Participants:
A national sample of emergency medicine (EM) physicians.
Methods:
Each vignette described a clinical scenario of a presumed SSTI (cellulitis or abscess) and included a unique combination of zero to five interventions (outpatient follow-up, inappropriate antibiotic request flag, thermal imaging for cellulitis or rapid wound MRSA PCR for abscess, patient education/shared decision-making, and clinical decision support). Out of 64 possible vignettes, we asked participants to respond to eight vignettes. Following each vignette, we asked participants if they would prescribe an antibiotic in their everyday practice (yes/no). We built adjusted hierarchical logistic regression models to estimate the probability of prescribing an antibiotic for each intervention and vignette.
Results:
Surveys were completed by 113 EM physicians. The thermal imaging, rapid wound MRSA PCR, and patient education/shared decision-making interventions showed the largest decrease (15–20%) in antibiotic prescribing probability. Vignettes with a combination of both a diagnostic intervention (thermal imaging or rapid wound MRSA PCR) and a patient education/shared decision-making intervention had the lowest prescribing probabilities.
Conclusion:
We recommend future research focuses on the development and integration of novel diagnostic tools to identify true infection and incorporate shared decision-making to improve diagnosis and management of SSTIs.
Adolescence is a critical developmental phase during which young people are vulnerable to the experiences of mental ill-health and social exclusion (consisting of various domains including education and employment, housing, finances and social supports and relationships). The aims of this study were to (i) obtain an understanding of the relationships between social exclusion, mental health and wellbeing of young people; and (ii) identify potentially modifiable targets, or population groups that require greater or targeted supports.
Methods
Data were obtained from the Mission Australia 2022 Youth Survey, Australia’s largest annual population-wide survey of young people aged 15–19 years (n = 18,800). Participants’ experiences of social exclusion in different domains were explored (e.g., prevalence, co-occurrence and controlling for differences in demographic characteristics). Multivariable linear regression models were used to map the relationships between social exclusion domains and mental health and wellbeing, controlling for confounding factors where necessary.
Results
Sixty per cent of all young people experienced social exclusion in at least one domain, 25% in multiple. Young people who identified as gender diverse, Indigenous, living in a remote/rural or socio-economically disadvantaged area and with a culturally diverse background were more likely to report social exclusion. A strong association was seen between all domains of social exclusion and poor mental health (e.g., higher psychological distress and loneliness, reduced personal wellbeing, reduced sense of control over their life and a more negative outlook on the future). Notably, difficulties in socialising and obtaining social support were critical factors linked to increased psychological distress and reduced wellbeing.
Conclusions
Findings underscore the need to address multiple domains of social exclusion concurrently, and in collaboration with youth mental healthcare. Prevention efforts aimed at early identification and intervention should be prioritised to support young people vulnerable to social exclusion. Screening approaches are needed to identify individuals and groups of young people in need of support, and to facilitate care coordination across multiple providers.
Increased ultra-processed food (UPF) is associated with adverse health outcomes. However, with limitations in UPF evidence, and partial overlap between UK front-of-package labelling (FOPL) and degree of food processing, the value of food processing within dietary guidance is unclear. This study compared food and drink from the UK National Diet and Nutrition Survey (NDNS) database based on micronutrient content, Nova classification and FOPL. The aim was to examine the micronutrient contributions of UK food and drink to UK government dietary micronutrient recommendations for adult females and males, aged 19–64 years, based on the degree of food processing and FOPL. NDNS items were coded into minimally processed food (MPF), processed culinary ingredients, processed food (PF) and UPF, and FOPL traffic lights. MPF, PF and UPF provided similar average contributions per 100 g to micronutrient recommendations. Per 100 kcal, MPF provided the greatest average contribution (14·4 % (interquartile range (IQR): 8·2–28·1)), followed by PF (7·7 % (IQR: 4·6–10·9) and then UPF (5·8 % (IQR: 3·1–9·7)). After adjusting for healthy/unhealthy items (presence of 1+ red FOPL), MPF had higher odds of an above-average micronutrient contribution per 100 kcal than UPF (OR: 5·9 (95 % CI 4·9–7·2)) and PF (OR: 3·2 (95 % CI 2·4–4·2)). MPF were more likely to provide greater contributions to micronutrient recommendations than PF or UPF per 100 kcal. These findings suggest that UPF or PF diets are less likely to meet micronutrient recommendations than an energy-matched MPF diet. The results are important for understanding how consumers perceive the healthiness of products based on FOPL.
Waterhemp has become a serious management challenge for field crop growers in New York. Two putative glyphosate-resistant (GR) waterhemp populations (NY1 and NY2) were collected in 2023 from two soybean fields in Seneca County, NY. The objectives of this research were to 1) confirm and characterize the level of glyphosate resistance in waterhemp populations from New York relative to a known glyphosate-susceptible population from Nebraska (NE_SUS), and 2) evaluate the efficacy of various postemergence herbicides for GR waterhemp control. Based on the shoot dry weight reductions (GR50 values) in a dose-response study, the NY1 and NY2 populations exhibited 5.6- to 8.3-fold resistance to glyphosate compared with the NE_SUS population. In a separate study, postemergence herbicides such as dicamba, glufosinate, lactofen, and 2,4-D applied alone or in a mixture with glyphosate or glufosinate had provided 89% to 99% control and ≥97% shoot dry weight reduction of NY1 and NY2 populations 21 d after treatment. Greater than 98% control of the NE_SUS population was achieved with tested postemergence herbicides, except mesotrione (62% control). Furthermore, atrazine, chlorimuron + thifensulfuron, and mesotrione were the least effective in controlling NY1 and NY2 populations (42% to 59% control and 50% to 67% shoot dry weight reductions, respectively). These results confirm the first report of GR waterhemp in New York. Growers should adopt effective alternative postemergence herbicides tested in this study to manage GR waterhemp.
The Antarctic Treaty System has put in place international agreements to provide comprehensive protection of the Antarctic environment. Despite this high degree of protection, human presence on the continent has resulted in environmental contamination, particularly at locations established prior to the development of the more stringent codes of conduct in recent decades. Rehabilitation of legacy contaminated sites is a priority for environmental management, and a framework for such efforts has been established. In this contribution, we re-evaluate the rehabilitation of the site of the former Vanda Station, a New Zealand outpost occupied from 1969 to 1991. We describe the design and implementation of the restoration, which included the removal of many tonnes of contaminated soils and groundwater, along with the post-action monitoring of the site. Our goal is to determine where challenges to the use of recent guidelines would have arisen. We found that while guidelines on clean-up of contaminated sites in Antarctica are valuable, challenges to implementation remain. These largely reflect a lack of understanding of the consequences of contamination on Antarctic ecosystems and the trajectory of natural rehabilitation. We present recommendations on how to address some of these challenges.
The topological concepts allow us to assign individuals and goals to certain spatial regions. They allow us to designate what locomotions are possible for an individual and what regions must be traversed in attaining a definite goal. But the topological concepts alone tell us nothing of the actual locomotions performed in psychological activities. So far we have seen that the position of the individual at the start of the psychological activity may be defined in reference to this. Psychological activities may be ordered to locomotions. The individual in this sense has the character of a thing. The space through which the locomotion occurs has the properties of a medium. (Cf. Heider (10). In physical problems where the field construct is used, one may make this same distinction. Bodies falling in the earth’s gravitational field have the properties of things, while the atmosphere is to be characterized as a medium. Similarly in the electro-static field, the isolated conductors have the properties of things and the field has those of a medium.
In 2010, the Commonwealth government proposed Australia's third attempt to give federal constitutional recognition to local government. In 2013, the government secured the passage through Parliament of a Constitution Alteration but, due to political events, and amid much controversy, the proposed amendment was not put to the people. This paper examines the merits and prospects for success of the proposed reform, with an eye to lessons for the future of local government's place in the federal system. It argues that the legal and constitutional cases for the alteration were strong, but limited, and poorly contextualised, theorised and articulated. We use public opinion evidence to conclude that had it proceeded, the referendum result would probably have been a third failure. These lessons are important for ongoing debate over sub-constitutional and constitutional reform to Australian intergovernmental relations, including questions of federal financial redistribution at the core of the proposal. Overall, the events of 2013 reinforce arguments that reforms to the position of local government, while important, should only be pursued as part of a holistic package of federal reform and renovation; and that more robust deliberative processes and principles must be adhered to before again attempting any constitutional reform.
For the readers of a journal devoted to the application of mathematics to psychological research it is scarcely necessary to spend much time in answering the question, “Why mathematics?” Science may best be defined as that set of postulates regarding experience to which the universal assent of competent observers may be obtained, plus the organization of such postulates into theories for which universal assent is likewise obtainable. Of all the propositions about nature those concerned with mathematics are most readily given universal assent. From this state of affairs the Kantian aphorism that a discipline is as scientific as it contains mathematics is entirely consequent. Kant himself doubted the applicability of mathematics to psychology and so was led to question the possibility of a scientific psychology. Fechher, as is well-known, thought differently and from Fechner‘s day the application of mathematical procedures has become an increasingly important part of psychological research until to-day we have a journal devoted to such application alone.
We consider the problem of least-squares fitting of squared distances in unfolding. An alternating procedure is proposed which fixes the row or column configuration in turn and finds the global optimum of the objective criterion with respect to the free parameters, iterating in this fashion until convergence is reached. A considerable simplification in the algorithm results, namely that this conditional global optimum is identified by performing a single unidimensional search for each point, irrespective of the dimensionality of the unfolding solution.
Antimicrobial stewardship programs (ASPs) aim to mitigate antimicrobial resistance (AMR) by optimizing antibiotic use including reducing unnecessary broad-spectrum therapy. This study evaluates the impact of ASP funding and resources on the use of broad-spectrum antibiotics in Ontario hospitals.
Methods:
We conducted a cross-sectional study of antimicrobial use (AMU) across 63 Ontario hospitals from April 2020 to March 2023. The Ontario ASP Landscape Survey provided data on ASP resourcing and antibiotic utilization. The main outcome was the proportion of all antibiotics that were broad-spectrum, defined as: fluoroquinolones; third-generation cephalosporins; beta-lactam/beta-lactamase inhibitors; carbapenems; clindamycin; and parenteral vancomycin. Secondary outcomes included the proportions of individual antibiotic classes listed above and anti-pseudomonal agents. Statistical analysis involved logistic regression to determine the odds ratio (OR) of the association between ASP funding/resourcing and broad-spectrum antibiotic use.
Results:
Among 63 hospitals, 48 reported designated ASP funding/resources. Median broad-spectrum antibiotic use was 52.5%. ASP funding/resources was not associated with overall broad-spectrum antibiotic use (0.97, 95% CI: 0.75–1.25, P = 0.79). However, funding was associated with lower use of fluoroquinolones (OR 0.67, 95% CI: 0.46–0.96, P = 0.03), clindamycin (OR 0.69, 95% CI: 0.47–1.00, P = 0.05), and anti-pseudomonal agents (OR 0.76, 95% CI: 0.59–0.98, P = 0.03).
Conclusion:
The presence of designated funding and resources for hospital ASPs is linked to reduced use of specific broad-spectrum antibiotics but not overall broad-spectrum antibiotic use. Enhancing ASP resourcing may be an important factor in limiting targeted antibiotic use, thereby increasing the effectiveness of efforts to mitigate AMR.
The majority of studies of mental health interventions for young adolescents have only evaluated short-term benefits. This study evaluated the longer-term effectiveness of a non-specialist delivered group-based intervention (Early Adolescent Skills for Emotions; EASE) to improve young adolescents’ mental health.
Methods
In this single-blind, parallel, controlled trial, Syrian refugees aged 10-14 years in Jordan who screened positive for psychological distress were randomised to receive either EASE or enhanced usual care (EUC). Primary outcomes were scores on the Paediatric Symptom Checklist (PSC) assessed at Week 0, 8-weeks, 3-months, and 12 months after treatment. Secondary outcomes were disability, posttraumatic stress, school belongingness, wellbeing, and caregivers’ reports of distress, parenting behaviour, and their perceived children’s mental health.
Results
Between June, 2019 and January, 2020, 185 adolescents were assigned to EASE and 286 to EUC, and 149 (80.5%) and 225 (78.7%) were retained at 12 months, respectively. At 12 months there were no significant differences between treatment conditions, except that EASE was associated with less reduction in depression (estimated mean difference -1.6, 95% CI –3.2 to -0.1; p=.03; effect size, -0.3), and a greater sense of school belonging (estimated mean difference -0.3, 95% CI –5.7 to -0.2; p=.03; effect size, 5.0).
Conclusions
Although EASE led to significant reductions in internalising problems, caregiver distress, and harsh disciplinary parenting at 3-months, these improvements were not maintained at 12 months relative to EUC. Scalable psychological interventions for young adolescents need to consider their ongoing mental health needs. Prospectively registered: ACTRN12619000341123.