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.
The change we propose [to the Australian Constitution] has very limited implications for the design of Australia's democracy. It is the so-called “minimalist” option. All the essential constitutional principles and practices which have worked well and evolved constructively over the last hundred years will remain in place.
The previous Australian government's aim was to remove the hereditary office of the monarch with only minor changes to the Australian system of government. Former Prime Minister Paul Keating stated that the proposed “republican” changes would have limited implications for the design and operation of Australian democracy. But his quest, and the quest of those who support the republican movement, may represent a more momentous shift in Australian political values and political sensibility than is widely admitted. This shift might lead to the enhancement of democratic participation. Indeed, the debate surrounding the republican initiative has already caused both a revised understanding of Australian political philosophy and a renewed appreciation of certain strong democratic threads in the history of Australia as a nation.
Evaluate knowledge and beliefs about dietary nitrate among United Kingdom (UK)-based adults.
Design:
An online questionnaire was administered to evaluate knowledge and beliefs about dietary nitrate. Overall knowledge of dietary nitrate was quantified using a twenty-one-point Nitrate Knowledge Index. Responses were compared between socio-demographic groups.
Setting:
UK.
Participants:
A nationally representative sample of 300 adults.
Results:
Only 19 % of participants had heard of dietary nitrate prior to completing the questionnaire. Most participants (∼70 %) were unsure about the effects of dietary nitrate on health parameters (e.g. blood pressure, cognitive function and cancer risk) or exercise performance. Most participants were unsure of the average population intake (78 %) and acceptable daily intake (83 %) of nitrate. Knowledge of dietary sources of nitrate was generally low, with only ∼30 % of participants correctly identifying foods with higher or lower nitrate contents. Almost none of the participants had deliberately purchased, or avoided purchasing, a food based around its nitrate content. Nitrate Knowledge Index scores were generally low (median (interquartile range (IQR)): 5 (8)), but were significantly higher in individuals who were currently employed v. unemployed (median (IQR): 5 (7) v. 4 (7); P < 0·001), in those with previous nutrition education v. no nutrition education (median (IQR): 6 (7) v. 4 (8); P = 0·012) and in individuals who had heard of nitrate prior to completing the questionnaire v. those who had not (median (IQR): 9 (8) v. 4 (7); P < 0·001).
Conclusions:
This study demonstrates low knowledge around dietary nitrate in UK-based adults. Greater education around dietary nitrate may be valuable to help individuals make more informed decisions about their consumption of this compound.
This article is a clinical guide which discusses the “state-of-the-art” usage of the classic monoamine oxidase inhibitor (MAOI) antidepressants (phenelzine, tranylcypromine, and isocarboxazid) in modern psychiatric practice. The guide is for all clinicians, including those who may not be experienced MAOI prescribers. It discusses indications, drug-drug interactions, side-effect management, and the safety of various augmentation strategies. There is a clear and broad consensus (more than 70 international expert endorsers), based on 6 decades of experience, for the recommendations herein exposited. They are based on empirical evidence and expert opinion—this guide is presented as a new specialist-consensus standard. The guide provides practical clinical advice, and is the basis for the rational use of these drugs, particularly because it improves and updates knowledge, and corrects the various misconceptions that have hitherto been prominent in the literature, partly due to insufficient knowledge of pharmacology. The guide suggests that MAOIs should always be considered in cases of treatment-resistant depression (including those melancholic in nature), and prior to electroconvulsive therapy—while taking into account of patient preference. In selected cases, they may be considered earlier in the treatment algorithm than has previously been customary, and should not be regarded as drugs of last resort; they may prove decisively effective when many other treatments have failed. The guide clarifies key points on the concomitant use of incorrectly proscribed drugs such as methylphenidate and some tricyclic antidepressants. It also illustrates the straightforward “bridging” methods that may be used to transition simply and safely from other antidepressants to MAOIs.
Objectives: The goal of the present study was to elucidate the influence of demographic and neuropathological moderators on the longitudinal trajectory neuropsychological functions during the first year after moderate to severe traumatic brain injury (TBI). In addition to examining demographic moderators such as age and education, we included a measure of whole-brain diffuse axonal injury (DAI), and examined measures of processing speed (PS), executive function (EF), and verbal learning (VL) separately. Methods: Forty-six adults with moderate to severe TBI were examined at 3, 6, and 12 months post-injury. Participants underwent neuropsychological evaluation and neuroimaging including diffusion tensor imaging. Using linear mixed effects modeling, we examined longitudinal trajectories and moderating factors of cognitive outcomes separately for three domains: PS, VL, and EF. Results: VL and EF showed linear improvements, whereas PS exhibited a curvilinear trend characterized by initial improvements that plateaued or declined, depending on age. Age moderated the recovery trajectories of EF and PS. Education and DAI did not influence trajectory but were related to initial level of functioning for PS and EF in the case of DAI, and all three cognitive domains in the case of education. Conclusions: We found disparate recovery trajectories across cognitive domains. Younger age was associated with more favorable recovery of EF and PS. These findings have both clinical and theoretical implications. Future research with a larger sample followed over a longer time period is needed to further elucidate the factors that may influence cognitive change over the acute to chronic period after TBI. (JINS, 2018, 24, 237–246)
Traumatic brain injury (TBI) is likely to disrupt structural network properties due to diffuse white matter pathology. The present study aimed to detect alterations in structural network topology in TBI and relate them to cognitive and real-world behavioral impairment. Twenty-two people with moderate to severe TBI with mostly diffuse pathology and 18 demographically matched healthy controls were included in the final analysis. Graph theoretical network analysis was applied to diffusion tensor imaging (DTI) data to characterize structural connectivity in both groups. Neuropsychological functions were assessed by a battery of psychometric tests and the Frontal Systems Behavior Scale (FrSBe). Local connection-wise analysis demonstrated reduced structural connectivity in TBI arising from subcortical areas including thalamus, caudate, and hippocampus. Global network metrics revealed that shortest path length in participants with TBI was longer compared to controls, and that this reduced network efficiency was associated with worse performance in executive function and verbal learning. The shortest path length measure was also correlated with family-reported FrSBe scores. These findings support the notion that the diffuse form of neuropathology caused by TBI results in alterations in structural connectivity that contribute to cognitive and real-world behavioral impairment. (JINS, 2014, 20, 1–10)
The models and analyses used in this study represent an important step in the continued search for the optimum use of surgery for the treatment of lower back pain. The likelihood of patients who are hospitalized with lower back pain in Massachusetts receiving either laminectomies or spinal fusions or both was increased when any of the following demographic, socioeconomic, or medical characteristics were present: white, male, well insured, young, routine admission, admitted to a medium-sized hospital, admitted to a teaching hospital, admitted to a hospital with a high occupancy rate, and discharged home.
During 1984–1985, laminectomy rates in Massachusetts demonstrated a 2.2-fold variation among districts. Thirty-five percent of laminectomies occurred in 7 of the 108 hospitals studied. Approximately 81% of laminectomies were performed by neurosurgeons. Rates of laminectomy decline with increasing age after 65, while rates of hospitalization for lower-back pain rise.
Clinicians and families report that traumatic brain injury results in a variety of attention deficits. Numerous laboratory studies have documented slowing of information processing, alteration in event-related potentials, or difficulty attending to specific relevant task dimensions in the presence of redundant information. However, little is known about how these information processing abnormalities relate to observable behaviors in daily living or work environments, which presumably form the basis for clinicians’ and families’ reports. We developed a quantitative assessment of behavioral inattentiveness in both quiet and distracting environments, and demonstrated excellent interrater reliability. Using this assessment, we have studied 20 patients with recent traumatic brain injury and 20 demographically comparable control subjects. We have confirmed marked differences in behavioral attentivencss between patients and controls in both distracting and nondistracting environments. (JINS, 1996, 2, 274–281.)
Frederick Mosteller was born in Clarksburg, West Virginia, at the time of the birth of medical technology assessment (10). During a long academic career at Harvard, he, probably more than any other person, contributed to techniques of assessment of therapy and outcome (6;14;29). Much of his seminal writing was published in the International Journal of Technology Assessment in Health Care (1;3;8;12;16;17;19;21–23).
Emerging evidence from recent studies using laboratory and
naturalistic attention tasks suggests that individuals with traumatic
brain injury (TBI) may have a deficit mainly in strategic control of
attention. In the present study, we tested the hypothesis that inattentive
behavior after TBI could be predicted by performance on psychometric
measures of executive function. A group of 37 individuals with moderate to
severe TBI were assessed with previously validated naturalistic measures
of attention. A battery of neuropsychological tests was also administered
to assess various aspects of executive function. Seven measures of
executive function and 10 variables reflecting inattentive behavior were
combined to form 1 executive and 3 inattentive behavior (IB) composite
scores. Three predictors (executive composite, current disability scores,
and age) were associated, at the univariate level, with one of the IB
composites reflecting frequency and duration of off-task episodes. A
stepwise multiple regression procedure indicated that the executive
composite was the only significant predictor of the IB composite.
Additional post-hoc regression analyses suggested that the
relationship was not likely to be mediated by processing speed. The
current study supports the hypothesis that executive function, measured by
commonly used neuropsychological tests, significantly predicts certain
aspects of inattentive behavior in real-world tasks after TBI.
(JINS, 2005, 11, 434–445.)
In order to understand what cognitive changes can be expected with aging versus those caused by disease, the New England Centenarian Study examined correlations between neuropsychological evaluation and neuropathological studies of centenarian subjects. Sixty-nine subjects were administered an extensive neuropsychological test battery designed for centenarians. Six brain donors from this group have subsequently died, and neuropathological studies of their brains have been performed to determine the presence of Alzheimer's disease (AD) and other pathological states. Of these six centenarians, three subjects had Clinical Dementia Rating scores of 0 and no dementia on neuropsychological testing, and subsequent neuropathology showed very limited AD changes. In fact, despite a range of neuropsychological findings, none of the subjects in this series met neuropathological criteria for a diagnosis of definite AD. Findings suggest that dementia is not inevitable with aging and that dementia in this age group is surprisingly often not attributable to AD.
Clinical assessments of individuals with traumatic
brain injury (TBI) typically report attentional difficulties,
with distractibility prominent among these complaints.
However, laboratory-based measures have often failed to
find disproportionate distraction among patients with TBI,
as compared to control participants. In this experiment,
we tested 21 patients hospitalized for rehabilitation following
recent TBI and 21 demographically comparable control subjects
on a visual reaction time go–no-go task in which
the target was preceded or followed by a brightly colored
moving visual stimulus, appearing above the target location.
Early distractors actually served as warning stimuli, improving
accuracy and speed for both participant groups. Distractors
occurring at or shortly after the time of target presentation
had no significant impact on accuracy or response bias
in either group, but did produce slowing of RT that was
significantly greater for patients than for controls. The
distractor that produced maximal slowing occurred 100 ms
after the presentation of the target or foil. Repeated
testing sessions led to reduction in the impact of the
distractor and loss of the group difference in RT impact.
The degree of RT slowing induced by distraction was modestly
related to injury severity, as measured by the current
score on the Disability Rating Scale, and the time until
the patient first followed verbal commands. There was also
a trend of greater RT slowing among individuals with focal
orbitofrontal lesions, as assessed on neuroimaging studies.
These results document a greater susceptibility to extraneous
visual distraction among patients with TBI in comparison
to controls. The fact that this difference appears only
in the RT domain, and is greatest when the distractor follows
the target, suggests that the primary impact of visual
distractors is on response preparation and execution rather
than target detection. (JINS, 1998, 4,
127–136).
Traumatic brain injury (TBI) is associated with
impairments of attention, most typically measured through
tests of information processing, or by subjective symptom
endorsement by patients, families, and clinicians. We have
previously shown increased rates of off-task behavior among
patients with TBI versus controls as defined by
videotaped records of independent work in distracting environments.
In this research, we report on a more detailed method of
coding such videotaped records which allows measurement
of the precise number of off-task behaviors, their durations,
and their relationship to distracting events. Using this
method, we studied 20 patients with recent moderate-to-severe
TBI and 20 demographically comparable controls as they
performed independent work tasks while being subjected
to controlled distracting events. This research confirms
that patients are markedly less attentive than controls
both in the presence of distractions and in their absence,
that distractions have an influence on off-task behavior
in both groups, and that the disruptive impact of distractors
wanes relatively quickly for controls but not for patients.
The duration of distraction produced by various classes
of distracting events appeared similar for patients and
controls, although the power to detect differences in behavioral
duration between groups was limited. The pattern of inattentiveness
among patients showed minimal relationship to measures
of injury severity within this sample. (JINS,
2000, 6, 1–11.)