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.
Background: Historically, diagnosis of urinary tract infections (UTIs) has been divided into 3 categories based on symptoms and urine culture results: not UTI, asymptomatic bacteriuria (ASB), or UTI. However, some populations (eg, older adults, catheterized patients) may not present with signs or symptoms referrable to the urinary tract or have chronic lower urinary tract symptoms (LUTS), making the diagnosis of UTI challenging. We sought to understand the clinical presentation of patients who receive urine tests in a cohort of diverse hospitals. Methods: This retrospective descriptive cohort study included all adult noncatheterized inpatient and ED encounters with paired urinalysis and urine cultures (24 hours apart) from 5 community and academic hospitals in 3 states (NC, VA, GA) between January 1, 2017, and December 31, 2019. Trained abstractors collected clinical and demographic data using a 60-question REDCap survey. The study group met with multidisciplinary experts (ID, geriatrics, urology) to define the “continuum of UTI” (Table 1), which includes 2 new categories: (1) LUTS to capture patients with chronic lower urinary tract symptoms and (2) bacteriuria of unclear significance (BUS) to capture patients who do not clinically meet criteria for ASB or UTI (eg, older adults who present with delirium and bacteriuria). The newly defined categories were compared to current guideline-based categories. We further compared ASB, BUS, and UTI categories using a lower bacterial threshold of 1,000 colony-forming units. Results: In total, 220,531 encounters met study criteria. After using a random number generator and removing duplicates, 3,392 encounters were included. Based on current IDSA guidelines, the prevalence of ASB was 32.1% (n = 975), and prevalence of patients with “not UTI” was 1,614 (53%). Applying the expert panel’s new “continuum of UTI” definitions, the prevalence of “not UTI” patients decreased to 1,147 (37.7%), due to reassignment of 467 patients (15.3%)to LUTS. The prevalence of ASB decreased by 24% due to reassignment to BUS. Lowering the bacterial threshold had a slight impact on the number of definitive UTIs (14.9 vs 15.9%) (Table 1). Conclusions: Our rigorous review of laboratory and symptom data from a diverse population dataset revealed that diagnostic uncertainty exists when assessing patients with suspicion for UTI. We propose moving away from dichotomous approach of ASB versus UTI and using the “continuum of UTI” for stewardship conversations. This approach will allow us to develop nuanced deprescribing interventions for patients with LUTS or BUS (eg, watchful waiting, shorter course therapy) that account for the unique characteristics of these populations.
The development of wearable technology, which enables motion tracking analysis for human movement outside the laboratory, can improve awareness of personal health and performance. This study used a wearable smart sock prototype to track foot–ankle kinematics during gait movement. Multivariable linear regression and two deep learning models, including long short-term memory (LSTM) and convolutional neural networks, were trained to estimate the joint angles in sagittal and frontal planes measured by an optical motion capture system. Participant-specific models were established for ten healthy subjects walking on a treadmill. The prototype was tested at various walking speeds to assess its ability to track movements for multiple speeds and generalize models for estimating joint angles in sagittal and frontal planes. LSTM outperformed other models with lower mean absolute error (MAE), lower root mean squared error, and higher R-squared values. The average MAE score was less than 1.138° and 0.939° in sagittal and frontal planes, respectively, when training models for each speed and 2.15° and 1.14° when trained and evaluated for all speeds. These results indicate wearable smart socks to generalize foot–ankle kinematics over various walking speeds with relatively low error and could consequently be used to measure gait parameters without the need for a lab-constricted motion capture system.
Sixty years have passed since occupiers in England and Wales were placed under a statutory duty to keep visitors to occupied premises reasonably safe. The legislation, however, did not detail the exact operation of this duty of care. The case law, expected to fill in the gaps, has arguably developed without sufficient consistency and/or predictability. This apparent confusion can be remedied through applying a systematic test to the question of whether a breach of duty has occurred. The test follows the verification that the case falls within the field of occupiers’ liability because of the presence of a danger attributable to the state of the premises. It consists of three consecutive stages which ask: (1) whether the risk of injury was foreseeable; (2) whether the occupier could reasonably have been expected to have addressed this very particular risk; and (3) whether any remedial action the occupier actually took was appropriate.
Item 9 of the Patient Health Questionnaire-9 (PHQ-9) queries about thoughts of death and self-harm, but not suicidality. Although it is sometimes used to assess suicide risk, most positive responses are not associated with suicidality. The PHQ-8, which omits Item 9, is thus increasingly used in research. We assessed equivalency of total score correlations and the diagnostic accuracy to detect major depression of the PHQ-8 and PHQ-9.
Methods
We conducted an individual patient data meta-analysis. We fit bivariate random-effects models to assess diagnostic accuracy.
Results
16 742 participants (2097 major depression cases) from 54 studies were included. The correlation between PHQ-8 and PHQ-9 scores was 0.996 (95% confidence interval 0.996 to 0.996). The standard cutoff score of 10 for the PHQ-9 maximized sensitivity + specificity for the PHQ-8 among studies that used a semi-structured diagnostic interview reference standard (N = 27). At cutoff 10, the PHQ-8 was less sensitive by 0.02 (−0.06 to 0.00) and more specific by 0.01 (0.00 to 0.01) among those studies (N = 27), with similar results for studies that used other types of interviews (N = 27). For all 54 primary studies combined, across all cutoffs, the PHQ-8 was less sensitive than the PHQ-9 by 0.00 to 0.05 (0.03 at cutoff 10), and specificity was within 0.01 for all cutoffs (0.00 to 0.01).
Conclusions
PHQ-8 and PHQ-9 total scores were similar. Sensitivity may be minimally reduced with the PHQ-8, but specificity is similar.
This study evaluated in a rigorous 18-month randomized controlled trial the efficacy of an enhanced vocational intervention for helping individuals with a recent first schizophrenia episode to return to and remain in competitive work or regular schooling.
Methods
Individual Placement and Support (IPS) was adapted to meet the goals of individuals whose goals might involve either employment or schooling. IPS was combined with a Workplace Fundamentals Module (WFM) for an enhanced, outpatient, vocational intervention. Random assignment to the enhanced integrated rehabilitation program (N = 46) was contrasted with equally intensive clinical treatment at UCLA, including social skills training groups, and conventional vocational rehabilitation by state agencies (N = 23). All patients were provided case management and psychiatric services by the same clinical team and received oral atypical antipsychotic medication.
Results
The IPS–WFM combination led to 83% of patients participating in competitive employment or school in the first 6 months of intensive treatment, compared with 41% in the comparison group (p < 0.005). During the subsequent year, IPS–WFM continued to yield higher rates of schooling/employment (92% v. 60%, p < 0.03). Cumulative number of weeks of schooling and/or employment was also substantially greater with the IPS–WFM intervention (45 v. 26 weeks, p < 0.004).
Conclusions
The results clearly support the efficacy of an enhanced intervention focused on recovery of participation in normative work and school settings in the initial phase of schizophrenia, suggesting potential for prevention of disability.
Different diagnostic interviews are used as reference standards for major depression classification in research. Semi-structured interviews involve clinical judgement, whereas fully structured interviews are completely scripted. The Mini International Neuropsychiatric Interview (MINI), a brief fully structured interview, is also sometimes used. It is not known whether interview method is associated with probability of major depression classification.
Aims
To evaluate the association between interview method and odds of major depression classification, controlling for depressive symptom scores and participant characteristics.
Method
Data collected for an individual participant data meta-analysis of Patient Health Questionnaire-9 (PHQ-9) diagnostic accuracy were analysed and binomial generalised linear mixed models were fit.
Results
A total of 17 158 participants (2287 with major depression) from 57 primary studies were analysed. Among fully structured interviews, odds of major depression were higher for the MINI compared with the Composite International Diagnostic Interview (CIDI) (odds ratio (OR) = 2.10; 95% CI = 1.15–3.87). Compared with semi-structured interviews, fully structured interviews (MINI excluded) were non-significantly more likely to classify participants with low-level depressive symptoms (PHQ-9 scores ≤6) as having major depression (OR = 3.13; 95% CI = 0.98–10.00), similarly likely for moderate-level symptoms (PHQ-9 scores 7–15) (OR = 0.96; 95% CI = 0.56–1.66) and significantly less likely for high-level symptoms (PHQ-9 scores ≥16) (OR = 0.50; 95% CI = 0.26–0.97).
Conclusions
The MINI may identify more people as depressed than the CIDI, and semi-structured and fully structured interviews may not be interchangeable methods, but these results should be replicated.
Declaration of interest
Drs Jetté and Patten declare that they received a grant, outside the submitted work, from the Hotchkiss Brain Institute, which was jointly funded by the Institute and Pfizer. Pfizer was the original sponsor of the development of the PHQ-9, which is now in the public domain. Dr Chan is a steering committee member or consultant of Astra Zeneca, Bayer, Lilly, MSD and Pfizer. She has received sponsorships and honorarium for giving lectures and providing consultancy and her affiliated institution has received research grants from these companies. Dr Hegerl declares that within the past 3 years, he was an advisory board member for Lundbeck, Servier and Otsuka Pharma; a consultant for Bayer Pharma; and a speaker for Medice Arzneimittel, Novartis, and Roche Pharma, all outside the submitted work. Dr Inagaki declares that he has received grants from Novartis Pharma, lecture fees from Pfizer, Mochida, Shionogi, Sumitomo Dainippon Pharma, Daiichi-Sankyo, Meiji Seika and Takeda, and royalties from Nippon Hyoron Sha, Nanzando, Seiwa Shoten, Igaku-shoin and Technomics, all outside of the submitted work. Dr Yamada reports personal fees from Meiji Seika Pharma Co., Ltd., MSD K.K., Asahi Kasei Pharma Corporation, Seishin Shobo, Seiwa Shoten Co., Ltd., Igaku-shoin Ltd., Chugai Igakusha and Sentan Igakusha, all outside the submitted work. All other authors declare no competing interests. No funder had any role in the design and conduct of the study; collection, management, analysis and interpretation of the data; preparation, review or approval of the manuscript; and decision to submit the manuscript for publication.
On a hot day in the 1960s Philip Rieff was out walking in his trademark threepiece suit, watch chain and bowler hat. An open- topped sports car pulled up with a young woman in the passenger seat. The driver, in T- shirt and shorts, was Erving Goffman, Rieff's departmental colleague at Pennsylvania. When he suggested to Rieff that he must be stifling in ‘that suit’, the latter looked at the woman and said: ‘Professor Goffman is a rich man who dresses like a poor man. I am poor man who dresses like a rich man’. A commentary of sorts on the presentation of self in everyday life, it was also itself a form of self- presentation, the retort to the colleague's joshing directed not at him but at the third party, and expressed through a conversation- stopping, conversation- preventing bon mot. Goffman himself would more likely analyze than use such a form of talk: though he did pepper his own texts with aphoristic expressions, they never stand alone but rather sum up passages of analysis. They also suggest an opening into further thoughts, as when, following discussion the ways in which people avoid embarrassment in the presence of nudity, he tells us that, ‘when bodies are naked, glances are clothed’. As writers, Rieff and Goffman can seem so different from one another that this alone might account for their differing levels of fame and influence. Where Goffman is dialogic and open, so ‘democratic’ that beginning students often take him to be saying something so obvious that they wonder what the fuss is about, Rieff, who should have found a place on ex- wife Susan Sontag's long list of all things camp, once said that there were only 17 people in the world who understood him. While neither characterization is quite right – Rieff's first two books are a reader's pleasure regardless of content, Goffman's essays are far more technical than they first appear, and he often introduced them as ‘reports’ – Goffman remains required reading for us all, while Rieff is a taste that few today acquire. It was not always so: Rieff was influential beyond sociology in the late 1950s and 1960s, then forgotten about by the 1980s, and picked up again around the time of his death in 2006.
This collection of essays explores the character and quality of the Holocaust’s impact and the abiding legacy it has left for social theory. The premise which informs the contributions is that, ten years after its publication, Zygmunt Bauman’s claim that social theory has either failed to address the Holocaust or protected itself from its implications remains true.
The terms Eem and Eemian have been applied to lithostratigraphic, chronostratigraphic, and biostratigraphic aspects of the last interglacial in western Europe. Eemian vegetational successions show strong uniformity at sites from western France across the North European Plain to Poland, suggesting, by comparison with the Holocene, that major pollen zones are broadly synchronous. South of the Alps and Pyrenees, a different vegetational succession is observed with no evidence for a substage of post-temperate cooling.
Yellow starthistle is an annual that is dependent on achene production, dispersal, and germination for stand renewal. Our purpose in this study was to determine the temperature relations for germination of achenes of this species. Germination temperature profiles were developed for achenes of yellow starthistle collected from 15 sites in California, Nevada, and Oregon. Each profile consisted of achene germination at 55 constant or alternating temperatures from 0 through 40 C. A total of 85 germination temperature profiles were developed by using the germination data to construct quadratic response surfaces through regression analysis. For most profiles, germination occurred at all the temperature regimes except a constant 40 C. This includes a constant 0 C and 0 alternating with 40 C. Rarely, there was no germination at 35 C and 35 C alternating with 40 C. The only evidence of afterripening requirements for achenes of yellow starthistle that we noted occurred at very cold temperature regimes. At those temperatures, the germination of dark-colored achenes without pappus increased 3 mo after harvest, and decreased for light-colored achenes with a pappus. No single temperature regime always supported optimum germination when all the profiles were combined. The most frequent optima was 2/20 C. Comparing all profiles for the Davis, CA, accession, there were 5 regimes (5 and 10 C cold periods alternating with 15 through 25 C warm periods) that always supported optimum germination. Light-colored achenes with pappus tended to have optimal germination at colder temperatures, and the dark-colored achenes at higher temperatures when seeds were tested immediately after harvest.
The last interglacial, commonly understood as an interval with climate as warm or warmer than today, is represented by marine isotope stage (MIS) 5e, which is a proxy record of low global ice volume and high sea level. It is arbitrarily dated to begin at approximately 130,000 yr B.P. and end at 116,000 yr B.P. with the onset of the early glacial unit MIS 5d. The age of the stage is determined by correlation to uranium–thorium dates of raised coral reefs. The most detailed proxy record of interglacial climate is found in the Vostok ice core where the temperature reached current levels 132,000 yr ago and continued rising for another two millennia. Approximately 127,000 yr ago the Eemian mixed forests were established in Europe. They developed through a characteristic succession of tree species, probably surviving well into the early glacial stage in southern parts of Europe. After ca. 115,000 yr ago, open vegetation replaced forests in northwestern Europe and the proportion of conifers increased significantly farther south. Air temperature at Vostok dropped sharply. Pulses of cold water affected the northern North Atlantic already in late MIS 5e, but the central North Atlantic remained warm throughout most of MIS 5d. Model results show that the sea surface in the eastern tropical Pacific warmed when the ice grew and sea level dropped. The essentially interglacial conditions in southwestern Europe remained unaffected by ice buildup until late MIS 5d when the forests disappeared abruptly and cold water invaded the central North Atlantic ca. 107,000 yr ago.
Suggestions that the duration of the Eemian interglacial was about 11,000 yr, based on annually laminated sediment sequences in Germany, have been challenged in favor of a much longer interval. However, biostratigraphic evidence demonstrates why the Eemian sequences at Grande Pile and Ribains cannot be reliably used for alignment with the marine sequence, as applied by Kukla et al. (2002, this issue) to estimate the duration of this interglacial. The long chronology they propose would imply not just coniferous but, for up to 5000 yr, fully temperate forest in central France coexisting with treeless heath and steppe tundra conditions in northwestern Europe, an unlikely climatic and ecological scenario. The proposal that the Eemian Interglacial in western Europe lasted for 17,000 or even 23,000 yr is rejected. A duration of no more than 13,000 yr is preferred, at least for sites north of the Alps and Pyrenees. The duration of temperate conditions in the Mediterranean region is less certain.
By
Charles Turner, teaches sociology at Warwick University, UK. He is the author of Modernity and Politics in the Work of Max Weber (1992), and Investigating Sociological Theory (2010).
The term “totalitarianism” is an awkward one. First, while the suffix “- ism” suggests an ideology, like liberalism or socialism, few have said “I am a totalitarian” in the way they have said “I am a liberal” or “I am a socialist.” Second, while “totalitarianism” is sometimes treated as the name of an object of inquiry, the adjective “totalitarian” is often used beyond the historical context in which it first arose. Ambiguity surrounds the scope of the term, too: Does it refer to forms of government, to types of state or to whole societies? Do we need it at all? Can we say what needs to be said by making use of other terms such as “tyranny” or “dictatorship”?
Totalitarianism between the Political and the Social
A popular misconception has it that “totalitarianism” is a product of the Cold War. To be sure, for some scholars and politicians it has served as a “counter concept” to “liberalism” or “democracy.” Yet when Hannah Arendt published The Origins of Totalitarianism in 1951, the word “totalitarian” was already more than 25 years old (Gleason 1995). It first appeared in Italy in 1923. Early that year, Mussolini had proposed a change in the Italian electoral law to allow the party with the largest share of the vote, as long as that was more than 25 per cent, to receive two- thirds of the seats in the parliament, and thus be able to change the constitution. On 12 May, the leftist journalist and politician Giovanni Amendola published an article in Il Mundo in which he described this as a recipe for “a totalitarian system” of rule; this he contrasted with two others: “majoritarian” and “minoritarian.” As can often happen in political life, Amendola's term for what he disapproved of was quickly adopted by those it was directed against. Mussolini himself referred to “our radical totalitarian will” and “the totalitarian state,” and in 1925 the Fascist theorist Giovanni Gentile went further and proposed a “total conception of life.” By this he meant that “it is impossible to be fascists in politics and non- fascists in schools, non- fascists in our families, non- fascists in our daily occupations.”
Gusts, says Duchêne, are more frequent when the machine is flying into the wind than with the wind, “for the simple reason that the gusts have a certain speed and the aeroplane therefore meets more of them (in the same space of time).” Elsewhere Duchêne refers to the experience of a pedestrian on a tramway route: in a given time a pedestrian meets more cars than those that overtake him.
I can see no parallel here, however, to meeting or following gusts in an aeroplane. Whether the machine is flying with the wind, or in the opposite direction to the stream of air, it has got to maintain its relative speed to the air: increase or decrease means a lift or a dip. So, as regards gusts in either case, the number met or overtaken would be the same. And it would seem that a following lull should have much the same effect on a machine as a head gust, and vice–versâ.