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.
We explore the necessarily comparative nature of CA’s methodology. We focus less on cross-linguistic comparisons, comparisons between talk-in-interaction in different settings, and comparisons between speakers from diverse speech communities. Instead, we consider the micro ways in which analysts work comparatively, ways that generally go unnoticed in accounts of CA’s methodology but which underpin our approach in data sessions, to building collections of phenomena, and even our research strategies when exploring certain linguistic or interactional forms. We demonstrate what can be learned from comparisons to be found in data, for example between the different responses by different participants to the same observation or question, or between different speakers’ versions of events, or from the different forms used by speakers when referring to the ‘same’ thing but in different action environments. We highlight the significance of speakers’ production of different versions of the ‘same’ something in their self-corrections. Finally, we illustrate the utility of a research strategy in which comparisons are made between speakers’ use of a certain reference form at one point in an interaction and the form they use at other points in the same interaction. In short, we explore the methodological significance of endogenous comparisons in data.
While scholars have long been interested in the formation, meaning, and uses of diminutive morphology across languages, the present study illustrates a novel approach to their examination. Drawing upon a corpus of recordings of Brazilian obstetric and gynecological consultations conducted in Portuguese, our analytic points of departure are action and the sequential progression of interaction. We address these by investigating moments where diminutive forms and base forms of a lexical item are used in close proximity. This approach allows us to unpack and particularize the generic, overarching function of ‘mitigation’ in terms of the specific actions being constituted by the participants—here, offering reassurance, attenuating intrusiveness, pursuing acquiescence, and launching activity transitions. We conclude by discussing some of the implications of this analysis and suggesting some potential avenues for future comparative research. (Portuguese, Brazil, gynecology, obstetrics, healthcare, morphology, pragmatics, granularity, methodology, conversation analysis)*
There are numerous challenges pertaining to epilepsy care across Ontario, including Epilepsy Monitoring Unit (EMU) bed pressures, surgical access and community supports. We sampled the current clinical, community and operational state of Ontario epilepsy centres and community epilepsy agencies post COVID-19 pandemic. A 44-item survey was distributed to all 11 district and regional adult and paediatric Ontario epilepsy centres. Qualitative responses were collected from community epilepsy agencies. Results revealed ongoing gaps in epilepsy care across Ontario, with EMU bed pressures and labour shortages being limiting factors. A clinical network advising the Ontario Ministry of Health will improve access to epilepsy care.
The aim of this study was to identify and prioritize strategies for strengthening public health system resilience for pandemics, disasters, and other emergencies using a scorecard approach.
Methods:
The United Nations Public Health System Resilience Scorecard (Scorecard) was applied across 5 workshops in Slovenia, Turkey, and the United States of America. The workshops focused on participants reviewing and discussing 23 questions/indicators. A Likert type scale was used for scoring with zero being the lowest and 5 the highest. The workshop scores were analyzed and discussed by participants to prioritize areas of need and develop resilience strategies. Data from all workshops were aggregated, analyzed, and interpreted to develop priorities representative of participating locations.
Results:
Eight themes emerged representing the need for better integration of public health and disaster management systems. These include: assessing community disease burden; embedding long-term recovery groups in emergency systems; exploring mental health care needs; examining ecosystem risks; evaluating reserve funds; identifying what crisis communication strategies worked well; providing non-medical services; and reviewing resilience of existing facilities, alternate care sites, and institutions.
Conclusions:
The Scorecard is an effective tool for establishing baseline resilience and prioritizing actions. The strategies identified reflect areas in most need for investment to improve public health system resilience.
Disaster research is primarily posthoc analysis, locally focused or within response organizations, overlooking the wellness and safety of first and second responders or the broad multi- and interdisciplinary activities necessary to foster and sustain recovery. A broad framework to span locality, institutional, and professional boundaries supports the development of a true learning community–a health EDRM sector that supports society in recognizing lessons, refining findings, and free and fluid global sharing.
Method:
Several organizations joined to create a robust disaster health learning community: CREDO, GloHSA, ICDM, and ECDM, a multi-national, multi-disciplinary collaborative network of patients, universities, societies, regulators, publishing, healthcare, and technology partners designed to foster expert level education and training with shared educational design concepts, milestones, and core curricula that embrace the strength of a standardized base upon which to link unique pillars of excellence of separate functions, institutions, nations, and regions.
Results:
The Emergency Disaster Global Health Sciences (EDGHS) model developed by University of Texas Southwestern Medical Center is interactive, open, and responsive. EDGHS addresses critical gaps in applied research by convening leaders across the healthcare and public health continuum to map the way forward, designing and implementing high-quality, evidence-based practical and policy research.
This defines essential public health functions for national contexts, including a focus on emergency preparedness and response, strengthening competency-based education on essential public health functions, and mapping and measurement of occupations delivering EDRM functions, offering an exportable model of global relevance.
Conclusion:
Putting disaster prevention into recovery processes is a strategic opportunity to improve the well-being of future generations. The survivability and well-being needs of present and future generations are contingent on knowledge-based, lived experiences of recoverable disaster loss and damage, and the capacity to thrive sustainably. This presentation serves as an invitation to join the growing momentum of creating a learning health EDRM community.
Obesity is highly prevalent and disabling, especially in individuals with severe mental illness including bipolar disorders (BD). The brain is a target organ for both obesity and BD. Yet, we do not understand how cortical brain alterations in BD and obesity interact.
Methods:
We obtained body mass index (BMI) and MRI-derived regional cortical thickness, surface area from 1231 BD and 1601 control individuals from 13 countries within the ENIGMA-BD Working Group. We jointly modeled the statistical effects of BD and BMI on brain structure using mixed effects and tested for interaction and mediation. We also investigated the impact of medications on the BMI-related associations.
Results:
BMI and BD additively impacted the structure of many of the same brain regions. Both BMI and BD were negatively associated with cortical thickness, but not surface area. In most regions the number of jointly used psychiatric medication classes remained associated with lower cortical thickness when controlling for BMI. In a single region, fusiform gyrus, about a third of the negative association between number of jointly used psychiatric medications and cortical thickness was mediated by association between the number of medications and higher BMI.
Conclusions:
We confirmed consistent associations between higher BMI and lower cortical thickness, but not surface area, across the cerebral mantle, in regions which were also associated with BD. Higher BMI in people with BD indicated more pronounced brain alterations. BMI is important for understanding the neuroanatomical changes in BD and the effects of psychiatric medications on the brain.
The large complex of archeological and paleontological sites of Melka Kunture is located about 50 km SSW of Addis Ababa (base camp coordinates 8.708° N, 38.594° E), on the banks of the Upper Awash in the Ethiopian plateau at elevations of 2000–2200 m a.s.l. (Figure 21.1); it includes numerous archeological sites that yield tens of thousands of artifacts. It has no equivalent in East Africa in documenting the full evolutionary sequence of lithic industries, from the late Oldowan to historic times, on the Ethiopian Highlands. It is also unique in providing abundant faunal remains that help reconstruct the diet of early hominins and, together with rich floral spectra, their environment at high altitudes.
Response to lithium in patients with bipolar disorder is associated with clinical and transdiagnostic genetic factors. The predictive combination of these variables might help clinicians better predict which patients will respond to lithium treatment.
Aims
To use a combination of transdiagnostic genetic and clinical factors to predict lithium response in patients with bipolar disorder.
Method
This study utilised genetic and clinical data (n = 1034) collected as part of the International Consortium on Lithium Genetics (ConLi+Gen) project. Polygenic risk scores (PRS) were computed for schizophrenia and major depressive disorder, and then combined with clinical variables using a cross-validated machine-learning regression approach. Unimodal, multimodal and genetically stratified models were trained and validated using ridge, elastic net and random forest regression on 692 patients with bipolar disorder from ten study sites using leave-site-out cross-validation. All models were then tested on an independent test set of 342 patients. The best performing models were then tested in a classification framework.
Results
The best performing linear model explained 5.1% (P = 0.0001) of variance in lithium response and was composed of clinical variables, PRS variables and interaction terms between them. The best performing non-linear model used only clinical variables and explained 8.1% (P = 0.0001) of variance in lithium response. A priori genomic stratification improved non-linear model performance to 13.7% (P = 0.0001) and improved the binary classification of lithium response. This model stratified patients based on their meta-polygenic loadings for major depressive disorder and schizophrenia and was then trained using clinical data.
Conclusions
Using PRS to first stratify patients genetically and then train machine-learning models with clinical predictors led to large improvements in lithium response prediction. When used with other PRS and biological markers in the future this approach may help inform which patients are most likely to respond to lithium treatment.
Disorders involving compulsivity, fear, and anxiety are linked to beliefs that the world is less predictable. We lack a mechanistic explanation for how such beliefs arise. Here, we test a hypothesis that in people with compulsivity, fear, and anxiety, learning a probabilistic mapping between actions and environmental states is compromised.
Methods
In Study 1 (n = 174), we designed a novel online task that isolated state transition learning from other facets of learning and planning. To determine whether this impairment is due to learning that is too fast or too slow, we estimated state transition learning rates by fitting computational models to two independent datasets, which tested learning in environments in which state transitions were either stable (Study 2: n = 1413) or changing (Study 3: n = 192).
Results
Study 1 established that individuals with higher levels of compulsivity are more likely to demonstrate an impairment in state transition learning. Preliminary evidence here linked this impairment to a common factor comprising compulsivity and fear. Studies 2 and 3 showed that compulsivity is associated with learning that is too fast when it should be slow (i.e. when state transition are stable) and too slow when it should be fast (i.e. when state transitions change).
Conclusions
Together, these findings indicate that compulsivity is associated with a dysregulation of state transition learning, wherein the rate of learning is not well adapted to the task environment. Thus, dysregulated state transition learning might provide a key target for therapeutic intervention in compulsivity.
Studying phenotypic and genetic characteristics of age at onset (AAO) and polarity at onset (PAO) in bipolar disorder can provide new insights into disease pathology and facilitate the development of screening tools.
Aims
To examine the genetic architecture of AAO and PAO and their association with bipolar disorder disease characteristics.
Method
Genome-wide association studies (GWASs) and polygenic score (PGS) analyses of AAO (n = 12 977) and PAO (n = 6773) were conducted in patients with bipolar disorder from 34 cohorts and a replication sample (n = 2237). The association of onset with disease characteristics was investigated in two of these cohorts.
Results
Earlier AAO was associated with a higher probability of psychotic symptoms, suicidality, lower educational attainment, not living together and fewer episodes. Depressive onset correlated with suicidality and manic onset correlated with delusions and manic episodes. Systematic differences in AAO between cohorts and continents of origin were observed. This was also reflected in single-nucleotide variant-based heritability estimates, with higher heritabilities for stricter onset definitions. Increased PGS for autism spectrum disorder (β = −0.34 years, s.e. = 0.08), major depression (β = −0.34 years, s.e. = 0.08), schizophrenia (β = −0.39 years, s.e. = 0.08), and educational attainment (β = −0.31 years, s.e. = 0.08) were associated with an earlier AAO. The AAO GWAS identified one significant locus, but this finding did not replicate. Neither GWAS nor PGS analyses yielded significant associations with PAO.
Conclusions
AAO and PAO are associated with indicators of bipolar disorder severity. Individuals with an earlier onset show an increased polygenic liability for a broad spectrum of psychiatric traits. Systematic differences in AAO across cohorts, continents and phenotype definitions introduce significant heterogeneity, affecting analyses.
Few bryozoans have been described from the Cretaceous Western Interior Seaway (WIS), which is consistent with the low diversity of other typically stenohaline groups in this large expanse of relatively shallow marine water. Here we describe a new cheilostome bryozoan, Conopeum flumineum n. sp., based on well-preserved material from the Campanian Judith River Formation of the Upper Missouri River Breaks National Monument in north-central Montana. The new species shows strong morphological similarities with Conopeum seurati, a Recent species that is often categorized as brackish, but which is euryhaline and can also be found in marine and stenohaline environments. The new Campanian bryozoan species was found in a locality also containing fragmentary remains of dinosaurs and other terrestrial vertebrates, as well freshwater mollusks and terrestrial plant debris. The sedimentology and facies associations of the fossil-bearing site suggest that the depositional setting was a swamp or tidally influenced fluvial backwater on the Judith River coastal plain. The proximity of the site to the western shoreline of the WIS presumably made it susceptible to occasional marine flooding during storms or extreme tides. Previous occurrences of Conopeum in the Cretaceous of the Western Interior have also been associated with dinosaur remains, corroborating the very nearshore and at times even ‘upstream’ distribution of this euryhaline genus.
Despite efforts to improve maternal and child nutrition, undernutrition remains a major public health challenge in Ghana. The current study explored community perceptions of undernutrition and context-specific interventions that could improve maternal and child nutrition in rural Northern Ghana.
Design:
This exploratory qualitative study used ten focus group discussions to gather primary data. The discussions were recorded, transcribed and coded into themes using Nvivo 12 software to aid thematic analysis.
Setting:
The study was conducted in rural Kassena-Nankana Districts of Northern Ghana.
Study participants:
Thirty-three men and fifty-one women aged 18–50 years were randomly selected from the community.
Results:
Most participants reported poverty, lack of irrigated agricultural land and poor harvests as the main barriers to optimal nutrition. To improve maternal and child nutrition, study participants suggested that the construction of dams at the community level would facilitate all year round farming including rearing of animals. Participants perceived that the provision of agricultural materials such as high yield seedlings, pesticides and fertiliser would help boost agricultural productivity. They also recommended community-based nutrition education by trained health volunteers, focused on types of locally produced foods and appropriate ways to prepare them to help improve maternal and child nutrition.
Conclusion:
Drawing on these findings and existing literature, we argue that supporting community initiated nutrition interventions such as improved irrigation for dry season farming, provision of agricultural inputs and community education could improve maternal and child nutrition.
Reintroduction to, or reinforcement of, threatened wild populations are commonly used conservation strategies. Reintroductions of the Southern Ground-hornbill Bucorvus leadbeateri have been tested as a potential conservation tool for this vulnerable species since 1995. Forty-two individuals have been reintroduced under varying management strategies. We analysed the outcomes of these attempts to assess which factors contributed most to success or failure. The species exhibits complex social learning and hierarchy, and is long-lived, with delayed sexual maturity. Immediate survival was significantly affected by the season in which the release was done and by the quality of the released birds. The best-quality release birds were reared with wild behavioural characteristics and were well-socialised to captive conspecifics prior to being placed into managed groups (‘bush schools’), where social learning was led by an experienced, wild alpha male. Once reintroduced birds had survived their first year after release, continued wild experience and wild mentorship significantly affected their survival. Since sample sizes limited the rigour of some statistical analyses, other factors were considered that may also determine success. These quasi-experimental reintroductions revealed novel threats to the species, such as the importance of a nest to group cohesion, that harvested second-hatched chicks provide viable release birds, which essentially doubles wild productivity, and that reintroductions generate valuable civil society awareness of the plight of the species.
The number of people entering specialist drug treatment for cannabis problems has increased considerably in recent years. The reasons for this are unclear, but rising cannabis potency could be a contributing factor.
Methods
Cannabis potency data were obtained from an ongoing monitoring programme in the Netherlands. We analysed concentrations of δ-9-tetrahydrocannabinol (THC) from the most popular variety of domestic herbal cannabis sold in each retail outlet (2000–2015). Mixed effects linear regression models examined time-dependent associations between THC and first-time cannabis admissions to specialist drug treatment. Candidate time lags were 0–10 years, based on normative European drug treatment data.
Results
THC increased from a mean (95% CI) of 8.62 (7.97–9.27) to 20.38 (19.09–21.67) from 2000 to 2004 and then decreased to 15.31 (14.24–16.38) in 2015. First-time cannabis admissions (per 100 000 inhabitants) rose from 7.08 to 26.36 from 2000 to 2010, and then decreased to 19.82 in 2015. THC was positively associated with treatment entry at lags of 0–9 years, with the strongest association at 5 years, b = 0.370 (0.317–0.424), p < 0.0001. After adjusting for age, sex and non-cannabis drug treatment admissions, these positive associations were attenuated but remained statistically significant at lags of 5–7 years and were again strongest at 5 years, b = 0.082 (0.052–0.111), p < 0.0001.
Conclusions
In this 16-year observational study, we found positive time-dependent associations between changes in cannabis potency and first-time cannabis admissions to drug treatment. These associations are biologically plausible, but their strength after adjustment suggests that other factors are also important.