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Cognitive behavioural therapists and practitioners often feel uncertain about how to treat post-traumatic stress disorder (PTSD) following rape and sexual assault. There are many myths and rumours about what you should and should not do. All too frequently, this uncertainty results in therapists avoiding doing trauma-focused work with these clients. Whilst understandable, this means that the survivor continues to re-experience the rape as flashbacks and/or nightmares. This article outlines an evidence-based cognitive behavioural therapy (CBT) approach to treating PTSD following a rape in adulthood. It aims to be a practical, ‘how to’ guide for therapists, drawing on the authors’ decades of experience in this area. We have included film links to demonstrate how to undertake each step of the treatment pathway. Our aim is for CBT practitioners to feel more confident in delivering effective trauma-focused therapy to this client group. We consider how to assess and formulate PTSD following a rape in adulthood, then how to deliver cognitive therapy for PTSD (CT-PTSD; Ehlers and Clark, 2000). We will cover both client and therapist factors when working with memories of rape, as well as legal, social, cultural and interpersonal considerations.
Key learning aims
To understand the importance of providing effective, trauma-focused therapy for survivors of rape in adulthood who are experiencing symptoms of PTSD.
To be able to assess, formulate and treat PTSD following a rape in adulthood.
How to manage the dissociation common in this client group.
To be able to select and choose appropriate cognitive, behavioural and imagery techniques to help with feelings of shame, responsibility, anger, disgust, contamination and mistrust.
For therapists to learn how best to support their own ability to cope with working in a trauma-focused way with survivors of rape and sexual violence.
This chapter asks what challenges the cartographic imaginary of literary nationalism might present to readers of three representative novels of the pre-Federation era: two of Ada Cambridge’s novels serialised at the time of Melbourne’s Centennial International Exhibition in 1888, A Black Sheep (later published as A Marked Man) and A Woman’s Friendship, and Catherine Martin’s An Australian Girl (1890). The aim is to wrest these late colonial texts back from the moment of Federation and its continental scale, relocating them once more in that earlier time, before the nation, whose cartographic imaginary was intra- and inter-colonial rather than national, albeit located within broader transnational or trans-imperial horizons. The point is to see the work of these late colonial writers not through the singular lens of literary nationalism, as harbingers of a unified national ethos, but as evidence of what historian Alan Atkinson has called the ’jigsaw work’ of Federation, with its multiple scales of knowable community and its two-way mirrors of transnational identity formation.
This paper investigates changes over time in the proportion of the male and female population aged 15 and over who are employed. It is especially aimed at studying the influence of changes in the age composition of the population on this indicator. The main findings are: (a) while the underlying trends for males and females are in the opposite direction, both male and female employment ratios fall in recession and rise in recoveries; (b) changes in the age composition of the population (ageing, per se) can explain only a very small amount of the changes in the aggregate employment ratio for both males and females over the period 1978–2001; (c) the falling aggregate male employment ratio is not primarily or even largely a result of movements out of employment by older workers, indeed, over half of the reduction in the aggregate employment ratio for males is due to falling employment ratios for prime working-age males. Policy implications are discussed in the concluding section.
This paper looks at the effects of changes in the age composition of the labour force on aggregate male and female unemployment rates. While it has been common to look at aggregate participation rate changes in terms of a weighted average over age groups this seems not to be the case for unemployment. We show in this paper that changes in the age composition of the labour force (driven mainly by changes in the age distribution of the population) has affected the aggregate unemployment rates in a systematic and, with hindsight, predictable manner. Amongst other things, we show that in the past decade or so, policy makers have benefited from a not inconsequential “free lunch” in that changes in the age composition of the labour force have been pulling the aggregate unemployment rates down below what it would otherwise be by around one percent of the labour force. We also show that this free lunch is now coming to an end.
This paper investigates two related matters. First, what proportion of the population is represented by the matched sample (i.e. by the gross flows data) in the Labour Force Survey, why is this proportion what it is and why does it vary over time? Second, given that around 20% of the population are not represented in the matched sample, how representative are labour market indices derived from the matched sample data and, if biases are present, what is the source and what are the implications of the bias?
This year marks the 200th anniversary of the birth of Karl Marx, the last of the classical political economists. This article aims to mark the occasion by drawing attention to some of his key works in economics and to present some of his ideas in a way that will make sense to readers not familiar with or very much interested in the complexities of the labour theory of value. I begin with a brief biography and a summary of his main works in economics. I then explore in some detail ideas related to the economic surplus, unpaid labour and exploitation, and attempt to tease out the implications of his analysis for the determination of the wage share. While I argue that Marx has not succeeded in providing adequate theoretical support for his prediction that the wage share will fall as capital accumulates, he has nonetheless provided a very interesting and insightful collection of ideas by which we may, even today, approach a wide range of issues relating to production and distribution.
Barrett’s oesophagus (BE) is the precursor of oesophageal adenocarcinoma, which has become the most common type of oesophageal cancer in many Western populations. Existing evidence on diet and risk of BE predominantly comes from case–control studies, which are subject to recall bias in measurement of diet. We aimed to investigate the potential effect of diet, including macronutrients, carotenoids, food groups, specific food items, beverages and dietary scores, on risk of BE in over 20 000 participants of the Melbourne Collaborative Cohort Study. Diet at baseline (1990–1994) was measured using a food frequency questionnaire. The outcome was BE diagnosed between baseline and follow-up (2007–2010). Logistic regression models were used to estimate OR and 95 % CI for diet in relation to risk of BE. Intakes of leafy vegetables and fruit were inversely associated with risk of BE (highest v. lowest quartile: OR = 0·59; CI: 0·38, 0·94; P-trend = 0·02 and OR = 0·58; CI: 0·37, 0·93; P-trend = 0·02 respectively), as were dietary fibre and carotenoids. Stronger associations were observed for food than the nutrients found in them. Positive associations were observed for discretionary food (OR = 1·54; CI: 0·97, 2·44; P-trend = 0·04) and total fat intake (OR per 10 g/d = 1·11; CI: 1·00, 1·23), the association for fat was less robust in sensitivity analyses. No association was observed for meat, protein, dairy products or diet scores. Diet is a potential modifiable risk factor for BE. Public health and clinical guidelines that incorporate dietary recommendations could contribute to reduction in risk of BE and, thereby, oesophageal adenocarcinoma.
The purpose of this study was to systematically review the process for topic selection by health technology assessment (HTA) agencies around the world to provide the knowledge base for the improvement of topic selection frameworks in HTA agencies.
Methods
A systematic search was conducted in PubMed and EMBASE to identify papers up to February 2019. Gray literature was identified by screening the Web sites of HTA agencies on the nonprofit member list of the International Network of Agencies for Health Technology Assessment (INAHTA). Data were extracted for each HTA agency and synthesized, with issues including general contextual information about each agency and the process of topic selection.
Results
Out of forty-nine nonprofit members of INAHTA, a total of seventeen HTA agencies with a framework for topic selection were identified from twenty-two included papers/documents. Multiple criteria were used for topic selection in all frameworks and agencies undertook multiple steps, which could include the specification of criteria for topic selection, identification of topics, short listing of potential topics, scoping of potential topics, scoring and ranking of potential topics, and deliberation and decision on final topics for HTA. Shortcomings were found in relation to methods of scoring and ranking as well as lack of monitoring and the evaluation of the process.
Conclusions
Our study provides insights into the current practice of topic selection in HTA agencies. Multiple criteria decision analysis methodology appears highly relevant to these processes. A consensus approach for the development of methods of topic selection would be valuable for the HTA community.
There is a large treatment gap for common mental disorders in rural areas of low-income countries. We tested the Friendship Bench as a brief psychological intervention delivered by village health workers (VHWs) in rural Zimbabwe.
Methods
Rural women identified with depression in a previous trial received weekly home-based problem-solving therapy from VHWs for 6 weeks, and joined a peer-support group. Depression was assessed using the Edinburgh Postnatal Depression Scale (EPDS) and Shona Symptom Questionnaire (SSQ). Acceptability was explored through in-depth interviews and focus group discussions. The proportion of women with depression pre- and post-intervention was compared using McNemar's test.
Results
Ten VHWs delivered problem-solving therapy to 27 women of mean age 33 years; 25 completed six sessions. Women valued an established and trustful relationship with their VHW, which ensured confidentiality and prevented gossip, and reported finding individual problem-solving therapy beneficial. Peer-support meetings provided space to share problems, solutions and skills. The proportion of women with depression or suicidal ideation on the EPDS declined from 68% to 12% [difference 56% (95% confidence interval (CI) 27.0–85.0); p = 0.001], and the proportion scoring high (>7) on the SSQ declined from 52% to 4% [difference 48% (95% CI 24.4–71.6); p < 0.001] after the 6-week intervention.
Conclusion
VHW-delivered problem-solving therapy and peer-support was acceptable and showed promising results in this pilot evaluation, leading to quantitative and qualitative improvements in mental health among rural Zimbabwean women. Scale-up of the Friendship Bench in rural areas would help close the treatment gap for common mental disorders.
To examine associations between diet and risk of developing gastro-oesophageal reflux disease (GERD).
Design:
Prospective cohort with a median follow-up of 15·8 years. Baseline diet was measured using a FFQ. GERD was defined as self-reported current or history of daily heartburn or acid regurgitation beginning at least 2 years after baseline. Sex-specific logistic regressions were performed to estimate OR for GERD associated with diet quality scores and intakes of nutrients, food groups and individual foods and beverages. The effect of substituting saturated fat for monounsaturated or polyunsaturated fat on GERD risk was examined.
Setting:
Melbourne, Australia.
Participants:
A cohort of 20 926 participants (62 % women) aged 40–59 years at recruitment between 1990 and 1994.
Results:
For men, total fat intake was associated with increased risk of GERD (OR 1·05 per 5 g/d; 95 % CI 1·01, 1·09; P = 0·016), whereas total carbohydrate (OR 0·89 per 30 g/d; 95 % CI 0·82, 0·98; P = 0·010) and starch intakes (OR 0·84 per 30 g/d; 95 % CI 0·75, 0·94; P = 0·005) were associated with reduced risk. Nutrients were not associated with risk for women. For both sexes, substituting saturated fat for polyunsaturated or monounsaturated fat did not change risk. For both sexes, fish, chicken, cruciferous vegetables and carbonated beverages were associated with increased risk, whereas total fruit and citrus were associated with reduced risk. No association was observed with diet quality scores.
Conclusions:
Diet is a possible risk factor for GERD, but food considered as triggers of GERD symptoms might not necessarily contribute to disease development. Potential differential associations for men and women warrant further investigation.
Two vanadates, tangeïte and volborthite, new to Britain, their association with vanadiferous nodules, and their geological environment are described. A percentage composition graph for vanadium taken across a vanadiferous nodule, by scanning electron probe, is given.
The castles of the late medieval period represent some of the finest medieval monuments in Britain, with an almost infinite capacity to fascinate and draw controversy. They are also a source of considerable academic debate. The contents of this volume represent key works in castle scholarship. Topics discussed include castle warfare, fortress customs, architectural design and symbolism, spatial planning and the depiction of castles in medieval romance. The contributions also serve to highlight the diversity of approaches to the medieval castle, ranging from the study of documentary and literary sources, analysis of fragmentary architectural remains and the recording of field archaeology. The result is a survey that offers an in-depth analysis of castle building from the thirteenth to the fifteenth centuries, and places castles within their broader social, architectural and political contexts.
Robert Liddiard is Professor of History, University of East Anglia.
Contributors: Nicola Coldstream, Charles Coulson, Philip Dixon, Graham Fairclough, P.A. Faulkner, John Goodall, Beryl Lott, Charles McKean, T.E. McNeill, Richard K. Morris, Michael Prestwich, Christopher Taylor, Muriel A. Whitaker.
To improve understanding of relationships between crop diversity, weed management practices, and weed population dynamics, we used data from a field experiment and matrix models to examine how contrasting crop rotations affect velvetleaf. We compared a 2-yr rotation system (corn–soybean) managed with conventional rates of herbicides with a 4-yr rotation (corn–soybean–triticale + alfalfa–alfalfa) that received 82% less herbicide. In November 2002, a pulse of velvetleaf seeds (500 seeds m−2) was added to 7- by 7-m areas within replicate plots of each crop phase–rotation system combination. Velvetleaf seed, seedling, and reproductive adult population densities, seed production, and seed losses to predators were measured during the next year. Velvetleaf seed production was greater in the 4-yr rotation than in the 2-yr rotation (460 vs. 16 seeds m−2). Averaged over 12 sampling periods from late May to mid-November 2003, loss of velvetleaf seeds to predators also was greater in the 4-yr rotation than in the 2-yr rotation (32 vs. 17% per 2 d). Modeling analyses indicated that velvetleaf density in the 4-yr rotation should decline if cumulative losses of seeds produced in the soybean phase exceeded 40%. Achieving such a level of predation appears possible, given the observed rates of velvetleaf seed predation. In addition, no tillage occurs in the 4-yr rotation for 26 mo after soybean harvest, thus favoring seed exposure on the soil surface to predators. Models that included estimates of seed predation indicated that to prevent increases in velvetleaf density, weed control efficacy in soybean must be ≥ 93% in the 2-yr rotation, but could drop to 86% in the 4-yr rotation. These results support the hypothesis that diverse rotations that exploit multiple stress and mortality factors, including weed seed predation, can contribute to effective weed suppression with less reliance on herbicides.
An extensive ancient archeologic site containing lithic artifacts and associated with mammoth remains was reported at Chinitna Bay, southern Alaska in 1943. The presence of such a site adjacent to the continental shelf at the base of the rugged Aleutian Range suggested that humans may have inhabited the inner shelf environment during the late Pleistocene at times of lowered sea level. Because of the site's potential significance, an interdisciplinary research team relocated and reinvestigated the area in 1978, but failed to find evidence of prehistoric human habitation. Geologic studies and radiocarbon dating indicate that the strata reported at the site are intertidal in origin, very late Holocene in age, and have undergone significant tectonic movement in the recent past. These observations indicate that the previously published observations of the Chinitna Bay site are probably invalid.
In 1980 a large proboscidean femur, probably Mammuthus sp., was found in situ in a bluff exposure at the mouth of the Tyone River in the northwestern part of the Copper River Basin, Alaska. The regional setting, stratigraphy, radiocarbon chronology, flora, and implications of the fossil locality, which represents the first documented occurrence of Pleistocene terrestrial mammalian fauna in southern Alaska, are described. Radiocarbon dates and stratigraphic relations at the site indicate that the sediments containing the fossil accumulated during the transition from interstadial to glacial conditions during terminal middle Wisconsin time. During this interval the immediate vicinity was unforested and large areas of south-central Alaska may have been available for faunal and possibly human habitation. This documented find, dated at 29,450 ± 610 14C yr B.P., extends the known range for Pleistocene mammals and possibly steppe-tundra conditions south-ward at least 150 km, and suggests that mountain passes through the Alaska Range to the north were ice free during the last part of the middle Wisconsin interstadial.