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Recent changes to US research funding are having far-reaching consequences that imperil the integrity of science and the provision of care to vulnerable populations. Resisting these changes, the BJPsych Portfolio reaffirms its commitment to publishing mental science and advancing psychiatric knowledge that improves the mental health of one and all.
Evidence for necrotising otitis externa (NOE) diagnosis and management is limited, and outcome reporting is heterogeneous. International best practice guidelines were used to develop consensus diagnostic criteria and a core outcome set (COS).
Methods
The study was pre-registered on the Core Outcome Measures in Effectiveness Trials (COMET) database. Systematic literature review identified candidate items. Patient-centred items were identified via a qualitative study. Items and their definitions were refined by multidisciplinary stakeholders in a two-round Delphi exercise and subsequent consensus meeting.
Results
The final COS incorporates 36 items within 12 themes: Signs and symptoms; Pain; Advanced Disease Indicators; Complications; Survival; Antibiotic regimes and side effects; Patient comorbidities; Non-antibiotic treatments; Patient compliance; Duration and cessation of treatment; Relapse and readmission; Multidisciplinary team management.
Consensus diagnostic criteria include 12 items within 6 themes: Signs and symptoms (oedema, otorrhoea, granulation); Pain (otalgia, nocturnal otalgia); Investigations (microbiology [does not have to be positive], histology [malignancy excluded], positive CT and MRI); Persistent symptoms despite local and/or systemic treatment for at least two weeks; At least one risk factor for impaired immune response; Indicators of advanced disease (not obligatory but mut be reported when present at diagnosis). Stakeholders were unanimous that there is no role for secondary, graded, or optional diagnostic items. The consensus meeting identified themes for future research.
Conclusion
The adoption of consensus-defined diagnostic criteria and COS facilitates standardised research reporting and robust data synthesis. Inclusion of patient and professional perspectives ensures best practice stakeholder engagement.
The Hierarchical Taxonomy of Psychopathology (HiTOP) has emerged out of the quantitative approach to psychiatric nosology. This approach identifies psychopathology constructs based on patterns of co-variation among signs and symptoms. The initial HiTOP model, which was published in 2017, is based on a large literature that spans decades of research. HiTOP is a living model that undergoes revision as new data become available. Here we discuss advantages and practical considerations of using this system in psychiatric practice and research. We especially highlight limitations of HiTOP and ongoing efforts to address them. We describe differences and similarities between HiTOP and existing diagnostic systems. Next, we review the types of evidence that informed development of HiTOP, including populations in which it has been studied and data on its validity. The paper also describes how HiTOP can facilitate research on genetic and environmental causes of psychopathology as well as the search for neurobiologic mechanisms and novel treatments. Furthermore, we consider implications for public health programs and prevention of mental disorders. We also review data on clinical utility and illustrate clinical application of HiTOP. Importantly, the model is based on measures and practices that are already used widely in clinical settings. HiTOP offers a way to organize and formalize these techniques. This model already can contribute to progress in psychiatry and complement traditional nosologies. Moreover, HiTOP seeks to facilitate research on linkages between phenotypes and biological processes, which may enable construction of a system that encompasses both biomarkers and precise clinical description.
Roll-to-roll slot-die coating with a meniscus guide is used to deposit several layers in a P-I-N perovskite solar cell stack, including the perovskite layer. The use of various length meniscus guides as part of the slot-die head allows controlled coating of these layers at a common coating speed. The length of meniscus guide used is optimised and related to the rheology of the coated ink and appropriate choice of meniscus guide length provides a way to avoid flooding of the coated area and improve coating definition. Initial coating trial results suggest the low-flow limit of slot-die coating is still applicable when using a meniscus guide, which is an important and previously unreported observation, application of this theory to meniscus guide coating provides a useful tool for rapidly determining the appropriate coating conditions that can be used as part of a manufacturing process. This is further explored through the deposition of perovskite solar cells by roll-to-roll slot-die coating. The perovskite layer is deposited using a sequential slot-die deposition process using a low toxicity dimethyl sulfoxide ink for the lead iodide layer, it is found that increasing the drying oven temperature and air flow rate can be used to improve the uniformity of the layer but this can also result in deformation of the plastic substrate. Functioning perovskite solar cells are demonstrated using this technique, but a large variation is found between device performances which is attributed to the poor uniformity of the perovskite layer and damage caused to the substrate by excessive heating.
Sleep disturbance is common on in-patient psychiatry wards. This study explored subjective and objective patterns of sleep disturbance and contributory environmental factors. Participants were recruited from mental health acute admission wards and had a range of subjective and objective assessments of sleep. Light intensity and noise levels were measured to characterise potential environmental causes for poor sleep.
Results
We recruited 20 patients; 15% were high risk for obstructive sleep apnoea. Nineteen participants reported poor sleep quality on the Pittsburgh Sleep Quality Index, and 90% had significant sleep fragmentation with objective measures. Inside light levels were low (day <200 lux and night <10 lux). Night sound levels were 40–90 db.
Clinical implications
Sleep disturbance was highly prevalent. Increased awareness of sleep disorders is needed. Modifiable environmental factors on the ward were implicated, therefore increased awareness and a change of approach to sleep disturbance in in-patient psychiatry is recommended.
Objectives: The aim of this study was to identify whether the three main primary progressive aphasia (PPA) variants would show differential profiles on measures of visuospatial cognition. We hypothesized that the logopenic variant would have the most difficulty across tasks requiring visuospatial and visual memory abilities. Methods: PPA patients (n=156), diagnosed using current criteria, and controls were tested on a battery of tests tapping different aspects of visuospatial cognition. We compared the groups on an overall visuospatial factor; construction, immediate recall, delayed recall, and executive functioning composites; and on individual tests. Cross-sectional and longitudinal comparisons were made, adjusted for disease severity, age, and education. Results: The logopenic variant had significantly lower scores on the visuospatial factor and the most impaired scores on all composites. The nonfluent variant had significant difficulty on all visuospatial composites except the delayed recall, which differentiated them from the logopenic variant. In contrast, the semantic variants performed poorly only on delayed recall of visual information. The logopenic and nonfluent variants showed decline in figure copying performance over time, whereas in the semantic variant, this skill was remarkably preserved. Conclusions: This extensive examination of performance on visuospatial tasks in the PPA variants solidifies some previous findings, for example, delayed recall of visual stimuli adds value in differential diagnosis between logopenic variant PPA and nonfluent variant PPA variants, and illuminates the possibility of common mechanisms that underlie both linguistic and non-linguistic deficits in the variants. Furthermore, this is the first study that has investigated visuospatial functioning over time in the PPA variants. (JINS, 2018, 24, 259–268)
This article examines encounters of women with the criminal justice system in Wales during the century before the Courts of Great Sessions were abolished in 1830. Drawing on evidence from cases of sexual assault and homicide, it argues that women who killed were rarely convicted or punished harshly. A gendered discretion of sorts also acted against rape victims, as trials never resulted in conviction. Using violence as a lens, the paper reveals a distinctively Welsh approach to criminal justice, and offers quantitative evidence on which further comparative studies of the history of law and crime in England and Wales may be based.
The Next Generation Transit Survey (NGTS) is a new ground-based survey for transiting exoplanets. Our primary goal is to find the first statistically-significant sample of Neptunes and super-Earths that are bright enough for radial velocity confirmation. By measuring precise masses and radii we will constrain the bulk composition and internal structure of planets that span the transition between the gas giants and terrestrial planets. Our brightest exoplanets will also be suitable for atmospheric characterisation with large facilities such as the VLT, JWST and the E-ELT. NGTS construction began in June 2013, and the survey is due to commence in 2014.
This article contributes to the literature on the history of medico-legal practice by using a survey of 535 poisoning cases to examine the emergence of forensic toxicological expertise in nineteenth-century English criminal trials. In emphasizing chemical expertise, it seeks both to expand upon a limited literature on the history of the subject, and to offer a contrast to studies of criminal poisoning that have tended to focus primarily on medical expertise. Poisoning itself is a topic of abiding interest to historians of forensic medicine and science because (together with insanity) it long tended to attract the greatest attention (and often confrontation) in criminal proceedings. In looking at a wide number of cases, however, it becomes apparent that few aroused true medico-legal controversy. Rather, the evidence from several hundred cases tried as felonies during the eighteenth and nineteenth centuries indicates that prior to the 1830s few presented any opportunity for “a battle of experts”. While Ian Burney and Tal Golan have shown that this was certainly not the case during the mid and late nineteenth century, this paper goes further by dividing the period under study into three distinct phases in order to show how expert testimony (and experts themselves) changed during the course of the century, and why this process opened a door to the potential for formalized controversy.
The post-genomic technologies are generating vast quantities of data but many nutritional scientists are not trained or equipped to analyse it. In high-resolution NMR spectra of urine, for example, the number and complexity of spectral features mean that computational techniques are required to interrogate and display the data in a manner intelligible to the researcher. In addition, there are often multiple underlying biological factors influencing the data and it is difficult to pinpoint which are having the most significant effect. This is especially true in nutritional studies, where small variations in diet can trigger multiple changes in gene expression and metabolite concentration. One class of computational tools that are useful for analysing this highly multivariate data include the well-known ‘whole spectrum’ methods of principal component analysis and partial least squares. In this work, we present a nutritional case study in which NMR data generated from a human dietary Cu intervention study is analysed using multivariate methods and the advantages and disadvantages of each technique are discussed. It is concluded that an alternative approach, called feature subset selection, will be important in this type of work; here we have used a genetic algorithm to identify the small peaks (arising from metabolites of low concentration) that have been altered significantly following a dietary intervention.
This study assessed the impact of changes in school food policy on student lunch consumption in middle schools
Methods
Two years of lunch food records were collected from students at three middle schools in the Houston, Texas area. During the first year, no changes occurred in the school food environment. After that school year was completed, chips and dessert foods were removed from the snack bars of all schools by the Food Service Director. Students recorded the amount and source of food and beverage items consumed. Point-of-service purchase machines provided a day-by-day electronic data file with food and beverage purchases from the snack bars during the 2-year period. Independent t-tests and time series analyses were used to document the impact of the policy change on consumption and sales data between the two years
Results
In general, student consumption of sweetened beverages declined and milk, calcium, vitamin A, saturated fat and sodium increased after the policy change. Snack chips consumption from the snack bar declined in year 2; however, consumption of snack chips and candy from vending increased and the number of vending machines in study schools doubled during the study period. Ice cream sales increased significantly in year 2
Conclusions
Policy changes on foods sold in schools can result in changes in student consumption from the targeted environments. However, if all environments do not make similar changes, compensation may occur
Since 1945, Britain’s financial services have been subject to considerable change, both in the scale of their contribution to the domestic economy, and in their character and operation. It is no surprise that the expansion of this sector and its success in relation to other key sectors has attracted the attention of economic historians. Dynamism within financial services seems to offer fertile ground for those seeking to explain the pattern and pace of recent economic development within the British economy, especially given its contrast with continued de-industrialisation in Britain during the last quarter of the twentieth century (see, for example, Clarke 1986: 186; Rybczynski 1988; Hutton 1995).
The most significant developments in this sector were concentrated in the 1980s and 1990s, these years seeing a wave of regulatory reform, increased fluidity of institutional functions, and a large growth in the scale of financial business undertaken. During the 1960s there had been increasing pessimism regarding the durability of Britain’s role as a dominant player in international financial markets, with financial services being seen as another casualty of Britain’s supposed relative economic decline. Yet, for much of the 1980s, London’s position as a financial centre seemed, once again, to be secure. Deregulation appears to have provided a strong positive impetus to the sector, augmenting expansion already evident within it. Business increased significantly, but economic recession during the late 1980s and early 1990s combined with various ‘financial scandals’ (including, for example, the Guinness, Barlow Clowes, and Maxwell pension fund crises) to deepen concern that liberalization of the regulations governing financial services might have gone too far, and was in fact creating new sources of instability.