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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.
Edited by
David Kingdon, University of Southampton,Paul Rowlands, Derbyshire Healthcare NHS foundation Trust,George Stein, Emeritus of the Princess Royal University Hospital
Bipolar disorder is an affective disorder defined on the basis of the presence of periods of elevated mood. Patients often present with depression, and previous episodes of elevated mood may be missed if not specifically explored during assessment. Bipolar disorder may be difficult to differentiate from other conditions causing mood instability and impulsivity. It is important to identify comorbidities such as substance use, neurodiversity and physical illnesses. The first-line treatment for mania is antipsychotic medication. Antidepressants are reported to have little to no efficacy in treating bipolar depression on average. Lithium is not the only long-term prophylactic agent, but it remains the gold standard, with good evidence that it reduces mood episodes and adverse outcomes. Monitoring is required to ensure lithium level is optimised and potential side-effects minimised.
Edited by
Richard Williams, University of South Wales,Verity Kemp, Independent Health Emergency Planning Consultant,Keith Porter, University of Birmingham,Tim Healing, Worshipful Society of Apothecaries of London,John Drury, University of Sussex
There is increasing awareness that working within the field of pre-hospital care can have psychosocial effects on clinicians. This chapter describes a systematic review of current knowledge of the psychosocial consequences of working in pre-hospital care. A considerable amount of research has been conducted, examining in particular whether practitioners develop burnout and psychiatric disorders, especially symptoms of post-traumatic stress and post-traumatic stress disorder (PTSD), as a result of their work. However, most studies did not fully assess whether practitioners developed clinically significant symptoms.. Instead, cross-sectional surveys and self-report questionnaires were used, which considerably overestimate the incidence of these problems. Perhaps the high scores on these questionnaires indicate that practitioners who work in pre-hospital care often suffer considerable stress and distress that can be the result of daily organisational and operational hassles, a high volume of work, lack of resources, and, less than has often been thought, attending unusual and high-profile incidents.
Recent evidence from case reports suggests that a ketogenic diet may be effective for bipolar disorder. However, no clinical trials have been conducted to date.
Aims
To assess the recruitment and feasibility of a ketogenic diet intervention in bipolar disorder.
Method
Euthymic individuals with bipolar disorder were recruited to a 6–8 week trial of a modified ketogenic diet, and a range of clinical, economic and functional outcome measures were assessed. Study registration number: ISRCTN61613198.
Results
Of 27 recruited participants, 26 commenced and 20 completed the modified ketogenic diet for 6–8 weeks. The outcomes data-set was 95% complete for daily ketone measures, 95% complete for daily glucose measures and 95% complete for daily ecological momentary assessment of symptoms during the intervention period. Mean daily blood ketone readings were 1.3 mmol/L (s.d. = 0.77, median = 1.1) during the intervention period, and 91% of all readings indicated ketosis, suggesting a high degree of adherence to the diet. Over 91% of daily blood glucose readings were within normal range, with 9% indicating mild hypoglycaemia. Eleven minor adverse events were recorded, including fatigue, constipation, drowsiness and hunger. One serious adverse event was reported (euglycemic ketoacidosis in a participant taking SGLT2-inhibitor medication).
Conclusions
The recruitment and retention of euthymic individuals with bipolar disorder to a 6–8 week ketogenic diet intervention was feasible, with high completion rates for outcome measures. The majority of participants reached and maintained ketosis, and adverse events were generally mild and modifiable. A future randomised controlled trial is now warranted.
This case study finds that disrespect by international expatriate managers towards local employees triggered long-term industrial unrest in the Indian subsidiary of the global car maker Toyota. Whilst innovative production models and their tools provide economic advantage to the company, the interaction of the application of the lean production model within the context of host country institutions often creates workplace disputation and unrest due to unilateralism and managerial hegemonies that overrides local customs and norms. The power of multinational enterprises to override or ignore institutional resistance and to inflict disrespect towards the local workforce can result in worker resistance, a lack of trust, and ongoing industrial unrest. This case study demonstrates how a lack of respect of local customs and workers grievances had long-lasting consequences in terms of the subsequent conflict and a poor industrial relations climate at the production plant in India.
To what extent have wages recently increased in Australia? Have these increases been excessive? There are a myriad of wage data series produced by the Australian Bureau of Statistics. These series reflect different questions and different perspectives about wages. In the context of the previously centralised wage determination process the dissection and analysis of aggregate wage series was an important exercise for industry and academic economists. However, the analysis and interpretation of aggregate wage data has become more difficult in the light of a number of developments: (a) falling award coverage, (b) the development and uneven spread of enterprise bargaining, (c) the industrial and demographic restructuring of the workforce, (d) the growth in non-wage benefits, (e) the growth in non-standard employment What are the available options for measuring aggregate wages growth in the light of these above developments? To what extent has recent wage growth been excessive?
Outsourcing is very much part of the neo-liberal agenda for the public sector. The rationale for transferring the provision of goods and services, traditionally the responsibility of governments to private enterprise lies in the perception of public sector inefficiency and the philosophy that reducing the role of government, is essential for the optimal performance of the economy. While the impact of outsourcing is not always easy to isolate given its coexistence with a variety of complementary neo-liberal strategies such as legislative attacks on trade unions, there is strong evidence to suggest that it has contributed significantly to the reduction of employment, wages and working conditions. This has occurred both as functions are transferred to the less regulated private sector and as those left in government employment are subjected to the impact of ongoing financial stringency in their struggle to compete with the private sector and hold on to their jobs.
It is recognised that for efficiency and equity reasons that governments need to implement active labour market programs (LMP). Such programs can help to improve the matching of labour supply and demand, reduce wage inflation pressures generated where labour markets are subject to supply shortages and bottlenecks, assist disadvantaged labour market participants obtain employment, help reduce poverty and income inequalities generated by the persistence of long-term unemployment, and they can raise overall productivity levels and living standards. What is at issue is not the need for LMP, but the type and mix of LMP required in Australia.
The government has embarked upon a substantially supply side orientated LMP aimed at improving the employment prospects of the unemployed. On the demand side this has been augmented by a private sector wage subsidy program (JOBSTART). Such a mix of LMP is inappropriate for addressing the labour market problems associated with a recession. The government should, as a matter of urgency, consider the immediate introduction of a public sector job creation scheme (PSJCS). The advantages of such a program include its potential to directly address the problem of long-term unemployment (LTU), assist disadvantaged communities and provide an effective work experience support for the plethora of supply side LMP. Such a program could be effectively delivered by utilising the existing administrative structures of the CES and local government.
The deterioration of the labour market associated with high and sustained rates of unemployment leads to forms of hidden unemployment and underemployment as well as a systematic decline in job quality. The ability of employers to reduce job quality is enhanced through conditions of persistent excess labour supply. In turn the State can challenge and erode conditions and standards that sustain job quality. Hence, falling job quality is another of the hidden costs of unemployment. This paper sets out the decline in job quality in Australia as manifested by the growth in non-standard employment arrangements and by the systematic erosion of the conditions associated with the standard employment model.
Investigations into new technologies, employment and working conditions are timeless and consequently have occupied research, public policy, and popular fiction for centuries. However, in addition to the uncertainty created by the introduction of new technologies, the current coronavirus pandemic, with its associated impact on health and the economy, has led to increased volatility across the globe. The global medical crisis arising from the worldwide spread of COVID-19 is predicted to lead to a global economic crisis and subsequent deep depression. The resultant economic, social and political repercussions are likely to be felt for years or even decades to come, equalling the great depression of the last century. Consequently, it is difficult to make long-term accurate predictions about the impact of new technologies on industry, society, and labour. In this context, the aim of this introductory article to the themed volume is to consider the potential challenges and opportunities associated with the Fourth Industrial Revolution technologies and potential impacts on work and workplaces. This introductory article comprises an international collection of research that examines the impact of technological change on employment and working conditions with consideration given to the additional impacts of the COVID-19 crisis.
The Third Way program for work, industrial relations and employment is examined. The discussion considers the publications of major third way proponents in the UK and Australia. It then considers what policies have been instituted under New Labour in the UK. The discussion then moves to the possibilities for Australia. Overall the Third Way program is either underdeveloped in some areas (eg the workplace) or largely following orthodox supply side policies in other areas (eg unemployment). The article concludes with a list of some of the important work and workplace issues that could be addressed by a new policy program.
Over the past two decades temporary agency work has increased in relation to most sectors and countries. This growth reflects the internationalisation of the agency business which, arguably, has come about due to demands for an ‘on-call just-in-time’ workforce. While temporary agency work possesses several conceptual and empirical challenges for researchers, it also poses challenges for regulators. This paper considers some of those challenges concerning various definitions, classifications and measurement of temporary work while comparing the Australian and Irish experience. It is concluded that while agency work in Australia and Ireland is modest, it is growing, and the conceptual and empirical problems associated with its under-recording pose difficulties for the design and implementation of a regulatory code for this sector.
The Australian Fair Pay Commission (AFPC) is the latest institution to be created by the Federal government in the industrial relations arena and is one of the key pillars of the Workplace Relations Amendment (Work Choices) Act 2005 (Cth) No. 153. In this article we examine the rationale for the establishment of the AFPC, outline the structure and operational details associated with the AFPC and compare it with the UK Low Pay Commission. The creation of the AFPC presumes some failings of the Australian Industrial Relations Commission with respect to its safety net wage case deliberations. We attempt to identify what these failings were. Finally, we consider what the implications of the creation of the AFPC will be. On this point the establishment of the AFPC must be placed in a context of ongoing legislative change to welfare access and in the other major developments in the Work Choices legislation, especially the creation of the Australian Fair Pay and Conditions Standard.
This article assesses the ‘Managing Diversity’ (MD) approach in Australia, examining its drivers, discussing its relationship to legislation designed to promote equity, and examining it as a set of management practices. It has been plausibly argued, on efficiency grounds, that responsibility for achieving equality objectives must be shifted to organisations as this links contextual conditions to organisational processes. However, even where there is some prescription and guidance such as that provided by Australian Equal Employment Opportunity (EEO) legislation targeted specifically to women employees, both practice and outcomes are variable. This is even more the case with MD where there are no guiding principles or legislative support. The article examines the best practice EEO and MD programs of Australian organisations to demonstrate the approaches and programs that are being developed at the workplace and to highlight the limitations of the ‘business case’ approach underlying such programs.
About one in every four Australian employees is a casual. The casual share has doubled over the past decade and continues to expand. This paper catalogues the growth of casual employment and discusses the characteristics of casual jobs and of those in casual jobs. The key analytical issue discussed is whether casual employment is a transitional employment arrangement on the road towards permanent employment conditions. Alternatively, is it a trap which is associated with job insecurity, low earnings and spells outside of employment? Although the evidence is partial and circumstantial, casual employment is a bridge for some and a trap for others. In particular, for those who wish to beak out of unemployment, casual employment is unlikely to be a transitional point on the road to a permanent job. This finding has important implications for the design of labour market programs.
This article compares the productivity and employment performance of the Australian and Irish economies over the 1990s, with particular emphasis on the different approaches to the role of information and communications technologies (ICT). Whereas Australia’s performance is characterised by the application and diffusion of ICT across a number of sectors, with indirect productivity and employment effects, Ireland has become a major producer of ICT products and services in its own right. The article traces the implications of these approaches for the pattern of growth and employment in both economies and also indicates their limitations. Ireland’s approach is limited by dependence on foreign investment, embodying externally generated technologies, though this is now being addressed by a policy interest in R&D support and the development of industry clusters and networks. On the other hand, Australia faces growing and possibly unsustainable deficits in its current account, driven by imports of knowledge-intensive goods and services, notwithstanding recent improvements in the terms of trade associated with higher prices for primary commodity exports.
Set theory is a branch of mathematics with a special subject matter, the infinite, but also a general framework for all modern mathematics, whose notions figure in every branch, pure and applied. This Element will offer a concise introduction, treating the origins of the subject, the basic notion of set, the axioms of set theory and immediate consequences, the set-theoretic reconstruction of mathematics, and the theory of the infinite, touching also on selected topics from higher set theory, controversial axioms and undecided questions, and philosophical issues raised by technical developments.