8 results
Direct and indirect predictors of medication adherence by adults with bipolar disorder
- B. Cohen, N. O’Rourke
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- Journal:
- European Psychiatry / Volume 65 / Issue S1 / June 2022
- Published online by Cambridge University Press:
- 01 September 2022, p. S404
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Introduction
Medication adherence by persons with bipolar disorder (BD) is inconsistent. This is disconcerting, as BD is treatment responsive, side-effects are few, and the impact of both hypo/manic and depressive mood episodes can be considerable (e.g., self-harm).
ObjectivesFor this study, we computed a path model to identify both direct and indirect predictors of medication adherence. This included both clinical and psychosocial independent variables (e.g., BD symptoms, psychological well-being, alcohol misuse).
MethodsFrom the BADAS (Bipolar Affective Disorder and older Adults) Study, we identified a global sample of adults with the BD. Participants were recruited using microtargeted, Facebook advertising. This sample included persons living in Canada, U.S., U.K., Ireland, Australia and New Zealand (M = 55.35 years, SD = 9.65).
ResultsDirect predictors included perceived cognitive failures and alcohol misuse. Of note, medication adherence is inversely associated with number of prescribed antipsychotic medications. Neither symptoms of depression nor hypo/mania emerged as direct predictors of medication adherence. Similarly, psychological well-being appears indirectly associated with adherence (via BD symptoms).
ConclusionsDespite the wide age range of participants (22 – 73 years), age did not emerge as a predictor of adherence. Nor do cognitive failures appear significantly associated with age suggesting that both young and older adults with BD perceived cognitive loss.
DisclosureNo significant relationships.
Diagnostic accuracy of a brief screening tool for attention deficit hyperactivity disorder in UK prison inmates
- S. Young, R. A. González, L. Mutch, I. Mallet-Lambert, L. O'Rourke, N. Hickey, P. Asherson, G. H. Gudjonsson
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- Journal:
- Psychological Medicine / Volume 46 / Issue 7 / May 2016
- Published online by Cambridge University Press:
- 12 February 2016, pp. 1449-1458
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Background
Attention deficit hyperactivity disorder (ADHD) is overrepresented in prison, making it imperative to identify a screening tool that can be quickly applied to efficiently detect the disorder. We explored the discrimination ability of a widely used ADHD screen, the Barkley Adult ADHD Rating Scale (BAARS-IV), against a clinical diagnostic interview. A brief version of the screen was then developed in order to simplify its use in the prison context, and maximize its diagnostic properties.
MethodA cross-sectional study of 390 male prison inmates was performed in the UK, all participants were screened and interviewed via the Diagnostic Interview for ADHD in Adults 2.0 (DIVA-2).
ResultsA total of 47 (12.1%) inmates screened positive for ADHD using the full BAARS-IV, and 96 (24.6%) were clinically diagnosed, for a sensitivity of 37.9 and a specificity of 96.3. Our models identified the six items that most predicted ADHD diagnosis, with adjusted odds ratios ranging from 2.66 to 4.58. Sensitivity, specificity and accuracy were 0.82, 0.84 and 0.84, respectively, for the developed brief scale, and 0.71, 0.85 and 0.81 for its validation. Weighted probability scores produced an area under the curve of 0.89 for development, and 0.82 for validation of the brief scale.
ConclusionsThe original BAARS-IV performed poorly at identifying prison inmates with ADHD. Our developed brief scale substantially improved diagnostic accuracy. The brief screening instrument has great potential to be used as an accurate and resource-effective tool to screen young people and adults for likely ADHD in the criminal justice system.
Contributors
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- By Mitchell Aboulafia, Frederick Adams, Marilyn McCord Adams, Robert M. Adams, Laird Addis, James W. Allard, David Allison, William P. Alston, Karl Ameriks, C. Anthony Anderson, David Leech Anderson, Lanier Anderson, Roger Ariew, David Armstrong, Denis G. Arnold, E. J. Ashworth, Margaret Atherton, Robin Attfield, Bruce Aune, Edward Wilson Averill, Jody Azzouni, Kent Bach, Andrew Bailey, Lynne Rudder Baker, Thomas R. Baldwin, Jon Barwise, George Bealer, William Bechtel, Lawrence C. Becker, Mark A. Bedau, Ernst Behler, José A. Benardete, Ermanno Bencivenga, Jan Berg, Michael Bergmann, Robert L. Bernasconi, Sven Bernecker, Bernard Berofsky, Rod Bertolet, Charles J. Beyer, Christian Beyer, Joseph Bien, Joseph Bien, Peg Birmingham, Ivan Boh, James Bohman, Daniel Bonevac, Laurence BonJour, William J. Bouwsma, Raymond D. Bradley, Myles Brand, Richard B. Brandt, Michael E. Bratman, Stephen E. Braude, Daniel Breazeale, Angela Breitenbach, Jason Bridges, David O. Brink, Gordon G. Brittan, Justin Broackes, Dan W. Brock, Aaron Bronfman, Jeffrey E. Brower, Bartosz Brozek, Anthony Brueckner, Jeffrey Bub, Lara Buchak, Otavio Bueno, Ann E. Bumpus, Robert W. Burch, John Burgess, Arthur W. Burks, Panayot Butchvarov, Robert E. Butts, Marina Bykova, Patrick Byrne, David Carr, Noël Carroll, Edward S. Casey, Victor Caston, Victor Caston, Albert Casullo, Robert L. Causey, Alan K. L. Chan, Ruth Chang, Deen K. Chatterjee, Andrew Chignell, Roderick M. Chisholm, Kelly J. Clark, E. J. Coffman, Robin Collins, Brian P. Copenhaver, John Corcoran, John Cottingham, Roger Crisp, Frederick J. Crosson, Antonio S. Cua, Phillip D. Cummins, Martin Curd, Adam Cureton, Andrew Cutrofello, Stephen Darwall, Paul Sheldon Davies, Wayne A. Davis, Timothy Joseph Day, Claudio de Almeida, Mario De Caro, Mario De Caro, John Deigh, C. F. Delaney, Daniel C. Dennett, Michael R. DePaul, Michael Detlefsen, Daniel Trent Devereux, Philip E. Devine, John M. Dillon, Martin C. Dillon, Robert DiSalle, Mary Domski, Alan Donagan, Paul Draper, Fred Dretske, Mircea Dumitru, Wilhelm Dupré, Gerald Dworkin, John Earman, Ellery Eells, Catherine Z. Elgin, Berent Enç, Ronald P. Endicott, Edward Erwin, John Etchemendy, C. Stephen Evans, Susan L. Feagin, Solomon Feferman, Richard Feldman, Arthur Fine, Maurice A. Finocchiaro, William FitzPatrick, Richard E. Flathman, Gvozden Flego, Richard Foley, Graeme Forbes, Rainer Forst, Malcolm R. Forster, Daniel Fouke, Patrick Francken, Samuel Freeman, Elizabeth Fricker, Miranda Fricker, Michael Friedman, Michael Fuerstein, Richard A. Fumerton, Alan Gabbey, Pieranna Garavaso, Daniel Garber, Jorge L. A. Garcia, Robert K. Garcia, Don Garrett, Philip Gasper, Gerald Gaus, Berys Gaut, Bernard Gert, Roger F. Gibson, Cody Gilmore, Carl Ginet, Alan H. Goldman, Alvin I. Goldman, Alfonso Gömez-Lobo, Lenn E. Goodman, Robert M. Gordon, Stefan Gosepath, Jorge J. E. Gracia, Daniel W. Graham, George A. Graham, Peter J. Graham, Richard E. Grandy, I. Grattan-Guinness, John Greco, Philip T. Grier, Nicholas Griffin, Nicholas Griffin, David A. Griffiths, Paul J. Griffiths, Stephen R. Grimm, Charles L. Griswold, Charles B. Guignon, Pete A. Y. Gunter, Dimitri Gutas, Gary Gutting, Paul Guyer, Kwame Gyekye, Oscar A. Haac, Raul Hakli, Raul Hakli, Michael Hallett, Edward C. Halper, Jean Hampton, R. James Hankinson, K. R. Hanley, Russell Hardin, Robert M. Harnish, William Harper, David Harrah, Kevin Hart, Ali Hasan, William Hasker, John Haugeland, Roger Hausheer, William Heald, Peter Heath, Richard Heck, John F. Heil, Vincent F. Hendricks, Stephen Hetherington, Francis Heylighen, Kathleen Marie Higgins, Risto Hilpinen, Harold T. Hodes, Joshua Hoffman, Alan Holland, Robert L. Holmes, Richard Holton, Brad W. Hooker, Terence E. Horgan, Tamara Horowitz, Paul Horwich, Vittorio Hösle, Paul Hoβfeld, Daniel Howard-Snyder, Frances Howard-Snyder, Anne Hudson, Deal W. Hudson, Carl A. Huffman, David L. Hull, Patricia Huntington, Thomas Hurka, Paul Hurley, Rosalind Hursthouse, Guillermo Hurtado, Ronald E. Hustwit, Sarah Hutton, Jonathan Jenkins Ichikawa, Harry A. Ide, David Ingram, Philip J. Ivanhoe, Alfred L. Ivry, Frank Jackson, Dale Jacquette, Joseph Jedwab, Richard Jeffrey, David Alan Johnson, Edward Johnson, Mark D. Jordan, Richard Joyce, Hwa Yol Jung, Robert Hillary Kane, Tomis Kapitan, Jacquelyn Ann K. Kegley, James A. Keller, Ralph Kennedy, Sergei Khoruzhii, Jaegwon Kim, Yersu Kim, Nathan L. King, Patricia Kitcher, Peter D. Klein, E. D. Klemke, Virginia Klenk, George L. Kline, Christian Klotz, Simo Knuuttila, Joseph J. Kockelmans, Konstantin Kolenda, Sebastian Tomasz Kołodziejczyk, Isaac Kramnick, Richard Kraut, Fred Kroon, Manfred Kuehn, Steven T. Kuhn, Henry E. Kyburg, John Lachs, Jennifer Lackey, Stephen E. Lahey, Andrea Lavazza, Thomas H. Leahey, Joo Heung Lee, Keith Lehrer, Dorothy Leland, Noah M. Lemos, Ernest LePore, Sarah-Jane Leslie, Isaac Levi, Andrew Levine, Alan E. Lewis, Daniel E. Little, Shu-hsien Liu, Shu-hsien Liu, Alan K. L. Chan, Brian Loar, Lawrence B. Lombard, John Longeway, Dominic McIver Lopes, Michael J. Loux, E. J. Lowe, Steven Luper, Eugene C. Luschei, William G. Lycan, David Lyons, David Macarthur, Danielle Macbeth, Scott MacDonald, Jacob L. Mackey, Louis H. Mackey, Penelope Mackie, Edward H. Madden, Penelope Maddy, G. B. Madison, Bernd Magnus, Pekka Mäkelä, Rudolf A. Makkreel, David Manley, William E. Mann (W.E.M.), Vladimir Marchenkov, Peter Markie, Jean-Pierre Marquis, Ausonio Marras, Mike W. Martin, A. P. Martinich, William L. McBride, David McCabe, Storrs McCall, Hugh J. McCann, Robert N. McCauley, John J. McDermott, Sarah McGrath, Ralph McInerny, Daniel J. McKaughan, Thomas McKay, Michael McKinsey, Brian P. McLaughlin, Ernan McMullin, Anthonie Meijers, Jack W. Meiland, William Jason Melanson, Alfred R. Mele, Joseph R. Mendola, Christopher Menzel, Michael J. Meyer, Christian B. Miller, David W. Miller, Peter Millican, Robert N. Minor, Phillip Mitsis, James A. Montmarquet, Michael S. Moore, Tim Moore, Benjamin Morison, Donald R. Morrison, Stephen J. Morse, Paul K. Moser, Alexander P. D. Mourelatos, Ian Mueller, James Bernard Murphy, Mark C. Murphy, Steven Nadler, Jan Narveson, Alan Nelson, Jerome Neu, Samuel Newlands, Kai Nielsen, Ilkka Niiniluoto, Carlos G. Noreña, Calvin G. Normore, David Fate Norton, Nikolaj Nottelmann, Donald Nute, David S. Oderberg, Steve Odin, Michael O’Rourke, Willard G. Oxtoby, Heinz Paetzold, George S. Pappas, Anthony J. Parel, Lydia Patton, R. P. Peerenboom, Francis Jeffry Pelletier, Adriaan T. Peperzak, Derk Pereboom, Jaroslav Peregrin, Glen Pettigrove, Philip Pettit, Edmund L. Pincoffs, Andrew Pinsent, Robert B. Pippin, Alvin Plantinga, Louis P. Pojman, Richard H. Popkin, John F. Post, Carl J. Posy, William J. Prior, Richard Purtill, Michael Quante, Philip L. Quinn, Philip L. Quinn, Elizabeth S. Radcliffe, Diana Raffman, Gerard Raulet, Stephen L. Read, Andrews Reath, Andrew Reisner, Nicholas Rescher, Henry S. Richardson, Robert C. Richardson, Thomas Ricketts, Wayne D. Riggs, Mark Roberts, Robert C. Roberts, Luke Robinson, Alexander Rosenberg, Gary Rosenkranz, Bernice Glatzer Rosenthal, Adina L. Roskies, William L. Rowe, T. M. Rudavsky, Michael Ruse, Bruce Russell, Lilly-Marlene Russow, Dan Ryder, R. M. Sainsbury, Joseph Salerno, Nathan Salmon, Wesley C. Salmon, Constantine Sandis, David H. Sanford, Marco Santambrogio, David Sapire, Ruth A. Saunders, Geoffrey Sayre-McCord, Charles Sayward, James P. Scanlan, Richard Schacht, Tamar Schapiro, Frederick F. Schmitt, Jerome B. Schneewind, Calvin O. Schrag, Alan D. Schrift, George F. Schumm, Jean-Loup Seban, David N. Sedley, Kenneth Seeskin, Krister Segerberg, Charlene Haddock Seigfried, Dennis M. Senchuk, James F. Sennett, William Lad Sessions, Stewart Shapiro, Tommie Shelby, Donald W. Sherburne, Christopher Shields, Roger A. Shiner, Sydney Shoemaker, Robert K. Shope, Kwong-loi Shun, Wilfried Sieg, A. John Simmons, Robert L. Simon, Marcus G. Singer, Georgette Sinkler, Walter Sinnott-Armstrong, Matti T. Sintonen, Lawrence Sklar, Brian Skyrms, Robert C. Sleigh, Michael Anthony Slote, Hans Sluga, Barry Smith, Michael Smith, Robin Smith, Robert Sokolowski, Robert C. Solomon, Marta Soniewicka, Philip Soper, Ernest Sosa, Nicholas Southwood, Paul Vincent Spade, T. L. S. Sprigge, Eric O. Springsted, George J. Stack, Rebecca Stangl, Jason Stanley, Florian Steinberger, Sören Stenlund, Christopher Stephens, James P. Sterba, Josef Stern, Matthias Steup, M. A. Stewart, Leopold Stubenberg, Edith Dudley Sulla, Frederick Suppe, Jere Paul Surber, David George Sussman, Sigrún Svavarsdóttir, Zeno G. Swijtink, Richard Swinburne, Charles C. Taliaferro, Robert B. Talisse, John Tasioulas, Paul Teller, Larry S. Temkin, Mark Textor, H. S. Thayer, Peter Thielke, Alan Thomas, Amie L. Thomasson, Katherine Thomson-Jones, Joshua C. Thurow, Vzalerie Tiberius, Terrence N. Tice, Paul Tidman, Mark C. Timmons, William Tolhurst, James E. Tomberlin, Rosemarie Tong, Lawrence Torcello, Kelly Trogdon, J. D. Trout, Robert E. Tully, Raimo Tuomela, John Turri, Martin M. Tweedale, Thomas Uebel, Jennifer Uleman, James Van Cleve, Harry van der Linden, Peter van Inwagen, Bryan W. Van Norden, René van Woudenberg, Donald Phillip Verene, Samantha Vice, Thomas Vinci, Donald Wayne Viney, Barbara Von Eckardt, Peter B. M. Vranas, Steven J. Wagner, William J. Wainwright, Paul E. Walker, Robert E. Wall, Craig Walton, Douglas Walton, Eric Watkins, Richard A. Watson, Michael V. Wedin, Rudolph H. Weingartner, Paul Weirich, Paul J. Weithman, Carl Wellman, Howard Wettstein, Samuel C. Wheeler, Stephen A. White, Jennifer Whiting, Edward R. Wierenga, Michael Williams, Fred Wilson, W. Kent Wilson, Kenneth P. Winkler, John F. Wippel, Jan Woleński, Allan B. Wolter, Nicholas P. Wolterstorff, Rega Wood, W. Jay Wood, Paul Woodruff, Alison Wylie, Gideon Yaffe, Takashi Yagisawa, Yutaka Yamamoto, Keith E. Yandell, Xiaomei Yang, Dean Zimmerman, Günter Zoller, Catherine Zuckert, Michael Zuckert, Jack A. Zupko (J.A.Z.)
- Edited by Robert Audi, University of Notre Dame, Indiana
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- The Cambridge Dictionary of Philosophy
- Published online:
- 05 August 2015
- Print publication:
- 27 April 2015, pp ix-xxx
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Infant botulism due to C. butyricum type E toxin: a novel environmental association with pet terrapins
- E. B. SHELLEY, D. O'ROURKE, K. GRANT, E. McARDLE, L. CAPRA, A. CLARKE, E. McNAMARA, R. CUNNEY, P. McKEOWN, C. F. L. AMAR, C. COSGROVE, M. FITZGERALD, P. HARRINGTON, P. GARVEY, F. GRAINGER, J. GRIFFIN, B. J. LYNCH, G. McGRANE, J. MURPHY, N. NI SHUIBHNE, J. PROSSER
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- Epidemiology & Infection / Volume 143 / Issue 3 / February 2015
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- 13 October 2014, pp. 461-469
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We describe two cases of infant botulism due to Clostridium butyricum producing botulinum type E neurotoxin (BoNT/E) and a previously unreported environmental source. The infants presented at age 11 days with poor feeding and lethargy, hypotonia, dilated pupils and absent reflexes. Faecal samples were positive for C. butyricum BoNT/E. The infants recovered after treatment including botulism immune globulin intravenous (BIG-IV). C. butyricum BoNT/E was isolated from water from tanks housing pet ‘yellow-bellied’ terrapins (Trachemys scripta scripta): in case A the terrapins were in the infant's home; in case B a relative fed the terrapin prior to holding and feeding the infant when both visited another relative. C. butyricum isolates from the infants and the respective terrapin tank waters were indistinguishable by molecular typing. Review of a case of C. butyricum BoNT/E botulism in the UK found that there was a pet terrapin where the infant was living. It is concluded that the C. butyricum-producing BoNT type E in these cases of infant botulism most likely originated from pet terrapins. These findings reinforce public health advice that reptiles, including terrapins, are not suitable pets for children aged <5 years, and highlight the importance of hand washing after handling these pets.
Chapter 24 - Policies for the Energy Technology Innovation System (ETIS)
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- By Arnulf Grubler, International Institute for Applied Systems Analysis, Austria and Yale University, Francisco Aguayo, El Colegio de México, Kelly Gallagher, Tufts University, Marko Hekkert, Utrecht University, Kejun Jiang, Energy Research Institute, Lynn Mytelka, United Nations University-MERIT, Lena Neij, Lund University, Gregory Nemet, University of Wisconsin, Charlie Wilson, Tyndall Centre for Climate Change Research, Per Dannemand Andersen, Technical University of Denmark, Leon Clarke, University of Maryland, Laura Diaz Anadon, Harvard University, Sabine Fuss, International Institute of Applied Systems Analysis, Martin Jakob, Swiss Federal Institute of Technology, Daniel Kammen, University of California, Ruud Kempener, Harvard University, Osamu Kimura, Central Research Institute of Electric Power Industry, Bernadette Kiss, Lund University, Anastasia O'Rourke, Big Room Inc., Robert N. Schock, World Energy Council, UK and Center for Global Security Research, Paulo Teixeira de Sousa, Jr., Federal University Mato Grosso, Leena Srivastava, The Energy and Resources Institute
- Global Energy Assessment Writing Team
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- Global Energy Assessment
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- 05 September 2012
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- 27 August 2012, pp 1665-1744
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Summary
Executive Summary
Innovation and technological change are integral to the energy system transformations described in the Global Energy Assessment (GEA) pathways. Energy technology innovations range from incremental improvements to radical breakthroughs and from technologies and infrastructure to social institutions and individual behaviors. This Executive Summary synthesizes the main policy-relevant findings of Chapter 24. Specific positive policy examples or key takehome messages are highlighted in italics.
The innovation process involves many stages – from research through to incubation, demonstration, (niche) market creation, and ultimately, widespread diffusion. Feedbacks between these stages influence progress and likely success, yet innovation outcomes are unavoidably uncertain. Innovations do not happen in isolation; interdependence and complexity are the rule under an increasingly globalized innovation system. Any emphasis on particular technologies or parts of the energy system, or technology policy that emphasizes only particular innovation stages or processes (e.g., an exclusive focus on energy supply from renewables, or an exclusive focus on Research and Development [R&D], or feed-in tariffs) is inadequate given the magnitude and multitude of challenges represented by the GEA objectives.
A first, even if incomplete, assessment of the entire global resource mobilization (investments) in both energy supply and demand-side technologies and across different innovation stages suggests current annual Research, Development & Demonstration (RD&D) investments of some US$50 billion, market formation investments (which rely on directed public policy support) of some US$150 billion, and an estimated US$1 trillion to US$5 trillion investments in mature energy supply and end-use technologies (technology diffusion).
Foreword
- Stephen Broadberry, University of Warwick, Kevin H. O'Rourke, Trinity College, Dublin
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- The Cambridge Economic History of Modern Europe
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- 05 August 2012
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- 24 June 2010, pp xvii-xviii
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Summary
It would be unthinkable for American undergraduates to be offered courses in the economic history of their own state, rather than the United States as a whole. In sharp contrast, most existing textbooks on European economic history are country-specific, implying the risk that students will misinterpret continent-wide phenomena as having been purely national in scope, and as having had purely national causes. The time has come for a textbook on European economic history that takes an explicitly pan-European approach, with the material organized by topic rather than by country.
This project thus aims to provide a unified economic history of modern Europe, explicitly modeled on R. Floud and D. McCloskey's (1981) path-breaking Cambridge Economic History of Britain. Each chapter has been written by two or three leading experts in the field, who between them have been able to cover all of the three major European regions (northern Europe, southern Europe, and central and eastern Europe). Following the pattern established by Floud and McCloskey, we have broken down the project into two volumes covering the periods 1700–1870 and 1870–2000. Each volume contains chapters based on the dominant themes of modern economic history: aggregate growth and cycles; sectoral analysis; and living standards. The approach is quantitative and makes explicit use of economic analysis, but in a manner that is accessible to undergraduates.
Preface
- Stephen Broadberry, University of Warwick, Kevin H. O'Rourke, Trinity College, Dublin
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- The Cambridge Economic History of Modern Europe
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- 05 August 2012
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- 24 June 2010, pp xiii-xiv
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Summary
It would be unthinkable for American undergraduates to be offered courses in the economic history of their own state, rather than the United States as a whole. In sharp contrast, most existing textbooks on European economic history are country-specific, implying the risk that students will misinterpret continent-wide phenomena as having been purely national in scope, and as having had purely national causes. The time has come for a textbook on European economic history that takes an explicitly pan-European approach, with the material organized by topic rather than by country.
This project thus aims to provide a unified economic history of modern Europe, explicitly modelled on the pathbreaking Cambridge Economic History of Britain (Floud and McCloskey, 1981). Each chapter has been written by two or three leading experts in the field, who between them were able to cover each of the three major European regions (northern Europe, southern Europe, and central and eastern Europe). Following the pattern established by Floud and McCloskey, we have broken down the project into two volumes, covering the periods 1700–1870 and 1870–2000 respectively. Each volume contains chapters based on the dominant themes of modern economic history: aggregate growth and cycles, sectoral analysis, and living standards. The approach is quantitative and makes explicit use of economic analysis, but in a manner that is accessible to undergraduates.
Changing practice in the radiation treatment of non-Hodgkin's lymphoma
- N. Mohammed, N. O’Rourke
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- Journal:
- Journal of Radiotherapy in Practice / Volume 2 / Issue 3 / September 2000
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- 21 August 2006, pp. 133-138
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Background: Radiotherapy is well established in the treatment of non-Hodgkin's lymphoma (NHL) but there is considerable variation in the radiotherapy regimens prescribed, even within one cancer centre. This paper compares the varying radiation schedules prescribed in the Beatson Oncology Centre, Glasgow, in a sample of patients treated in 1996 with a second sample treated in 1999 following the creation of a lymphoma team with defined treatment protocols.
Method: In 1997 a retrospective study within the Beatson Oncology Centre recorded the treatment details of 35 patients treated with radiotherapy for NHL in 1996. The various radiotherapy dose and fractionation regimens prescribed were analysed to identify the rationale behind the variations by correlating them to the grade of disease, the age of the patient, the prescribing consultant and use of cytotoxic chemotherapy. A further audit of 36 patients treated over a three-month period in 1999 re-examined the radiotherapy prescribed and was able to include intent of treatment and stage of disease in the analysis.
Results: The demographics of the 1996 and 1999 patients were similar. In the latter group all patients had grade of disease recorded and 83% had stage recorded compared to 91% had grade and only 31% had stage recorded in 1996. The range of doses prescribed was 20–45 Gy (Gray) (median 36) for LGNHL (low grade non-Hodgkin's lymphoma) in 1996 with a range of 5–50 Gy (median 30) for HGNHL (high grade NHL). In 1999 the LGNHL range was 20–45 Gy (median 30) with HGNHL 20–50 (median 40). The 1999 audit showed better recording of data and this allowed further analysis of radiotherapy regimens. The patients could be grouped into three categories of treatment intent: primary radical treatment with radiotherapy alone (36%), consolidation following chemotherapy (25%) and palliation (39%). The radical and consolidation groups received similarly high doses (median 40 Gy) which were significantly greater than the palliation group (median 20 Gy).
Conclusions: The creation of a lymphoma team has improved the recording of treatment data and reduced the variations in clinical practice. We would advocate that patients with NHL should be irradiated according to evidence based protocols and suitable patients should be considered for the current BNLI trial of radiation dose in NHL.