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In 1924 William Watson gave a brief survey of the occurrence in Scotland of personal names containing the names of saints. He observed an interesting coincidence of such names with place-names commemorating the same saints, and declared that further research on the matter might bear fruit. This research, over ninety years later, has yet to be done in any systematic way. I would like now to highlight some cases which strengthen Watson's arguments, and to examine one rich but late source which, while providing few answers, raises the kinds of questions we might ask, should further research be conducted.
There is a dearth of work done on personal names containing saints’ names in Scotland despite their frequency and wide spread over time and space. Watson's study is broad but does not go into much depth, while research into individual names, such as that by D. C. McWhannell on Mac Gilla Conaill, drills deeper, but covers only a handful of names. Notable work has been done by Fiona Edmonds but this covers only a portion of Scotland (the southwest), and is mostly concerned with forenames such as Gilla Pátraic.
I would like here to follow Watson in looking at surnames, in particular those containing Gilla or Máel. In order to underpin this work, however, further study is still desirable on the origins of these names as forenames: on why (precisely) such a name might be applied in the first place, on continuity of use (and difference) between Ireland and Scotland, and on the influence of the Norse and Anglo-Normans on their development. David Thornton, who repeats Watson's call for a systematic programme of work to be advanced, has made some important (though tentative) suggestions in this regard; I will follow him here in referring to this class of names as hagiophoric (‘saint-bearing’) names.
Gilla names first appear in the annals in the tenth century, usually in conjunction with a saint's name. Gilla means ‘servant’ or ‘lad’, so Gilla Faeláin, for example, means servant (or devotee) of St Faelán. When put in the genitive in a patronymic or a surname, this becomes Mac Gilla Fhaeláin/ScG Mac Ghille Fhaolain; later contraction to Mac ‘Ill'Fhaolain results in the Anglicized surname MacLellan.
Use latent class analysis (LCA) to identify patterns of cognitive functioning in a sample of older adults with clinical depression and without dementia and assess demographic, psychiatric, and neurobiological predictors of class membership.
Neuropsychological assessment data from 121 participants in the Alzheimer’s Disease Neuroimaging Initiative-Depression project (ADNI-D) were analyzed, including measures of executive functioning, verbal and visual memory, visuospatial and language functioning, and processing speed. These data were analyzed using LCA, with predictors of class membership such as depression severity, depression and treatment history, amyloid burden, and APOE e4 allele also assessed.
A two-class model of cognitive functioning best fit the data, with the Lower Cognitive Class (46.1% of the sample) performing approximately one standard deviation below the Higher Cognitive Class (53.9%) on most tests. When predictors of class membership were assessed, carrying an APOE e4 allele was significantly associated with membership in the Lower Cognitive Class. Demographic characteristics, age of depression onset, depression severity, history of psychopharmacological treatment for depression, and amyloid positivity did not predict class membership.
LCA allows for identification of subgroups of cognitive functioning in a mostly cognitively intact late life depression (LLD) population. One subgroup, the Lower Cognitive Class, more likely to carry an APOE e4 allele, may be at a greater risk for subsequent cognitive decline, even though current performance on neuropsychological testing is within normal limits. These findings have implications for early identification of those at greatest risk, risk factors, and avenues for preventive intervention.
Introduction: Abdominal pain is one of the most frequent reasons for an emergency department (ED) visit. Most cases are functional and no therapy has proven effective. Our objective was to determine if hyoscine butylbromide (HBB) (BuscopanTM) is effective for children who present to the ED with functional abdominal pain. Methods: We conducted a randomized, blinded, superiority trial comparing HBB 10 mg plus acetaminophen placebo to oral acetaminophen 15 mg/kg (max 975 mg) plus HBB placebo using a double-dummy approach. We included children 8-17 years presenting to the ED at London Health Sciences Centre with colicky abdominal pain rated >40 mm on a 100 mm visual analog scale (VAS). The primary outcome was VAS pain score at 80 minutes post-administration. Secondary outcomes included adverse effects; caregiver satisfaction with pain management using a five-item Likert scale; recidivism and missed surgical diagnoses within 24-hours of discharge. Analysis was based on intention to treat. Results: We analyzed 225 participants (112 acetaminophen; 113 HBB). The mean (SD) age was 12.4 (3.0) years and 148/225 (65.8%) were females. Prior to enrollment, the median (IQR) duration of pain prior was 2 (4.5) hours and analgesia was provided to 101/225 (44.9%) of participants. The mean (SD) pre-intervention pain scores in the acetaminophen and HBB groups were 62.7 (15.9) mm and 60.3 (17.3) mm, respectively. At 80 minutes, the mean (SD) pain scores in the acetaminophen and HBB groups were 30.1 (28.8) mm and 29.4 (26.4) mm, respectively and there were no significant differences adjusting for pre-intervention scores (p = 0.96). The median (IQR) caregiver satisfaction was high in the acetaminophen [5 (2)] and HBB [5 (1)] groups (p = 0.79). The median (IQR) length of stay between acetaminophen [235 (101)] and HBB [234 (103)] was not significantly different (p = 0.53). The proportion of participants with a return visit for abdominal pain was 4/112 (3.5%) in the acetaminophen group and 6/113 (5.3%) in the HBB group. The most common adverse effect was nausea (9% in each group) and there were no significant differences in adverse effects between acetaminophen (26/112, 23.2%) and HBB (31/113, 27.4%) (p = 0.52). There were no missed surgical diagnoses. Conclusion: For children with presumed functional abdominal pain who present to the ED, both acetaminophen and HBB produce a clinically important (VAS < 30 mm) reduction in pain and should be routinely considered in this clinical setting.
Death by suicide is often preceded by attempted suicide, suicidal ideation and non-suicidal self-injury. These extreme thoughts and behaviours have been considered in terms of a continuum of suicidality. Little known research, however, has considered a suicide continuum that extends beyond these extreme thoughts and behaviours and incorporates a much wider array of phenomena that may vary in severity and may constitute a broader negative self-evaluation (NSE) continuum.
Harvesting key indicators of NSE from a British epidemiological survey (N = 8580), the current study used exploratory factor analysis, confirmatory factor analysis and factor mixture modelling to (i) identify the dimensional structure of NSE in the general population and (ii) profile the distribution of the resultant NSE dimensions. Multinomial logistic regression was then used to differentiate between classes using an array of risk variables, psychopathology outcome variables and a suicide attempt indicator.
A 4-factor model that reflected graded levels of NSE was identified; (F1) Low self-worth & subordination (F2) depression, (F3) suicidal thoughts, (F4) self-harm (SH). Seven classes suggested a clear pattern of NSE severity. Classes characterised by higher levels across the dimensions exhibited greater risk and poorer outcomes. The greatest risk for suicide attempt was associated with a class characterised by engagement in SH behaviour.
Low self-worth, subordination and depression, while representative of distinct groups in the population are also highly prevalent in those who entertain suicidal thoughts and engage in SH behaviour. The findings promote further investigation into the genesis and evolution of suicidality and internal threat.
Objectives: The purpose of this exploratory study was to identify clinical predictors that could distinguish clients’ level of engagement in inpatient rehabilitation following stroke. Methods: This is a secondary analysis of pooled data from three randomized controlled trials that examined the effects of a behavioral intervention. The sample (n=208) consisted of clients with stroke who had cognitive deficits (Quick-EXIT≥3) and were admitted to inpatient rehabilitation facilities associated with a university medical center. Individuals with pre-morbid dementia, aphasia and mood disorders were excluded. The Pittsburgh Rehabilitation Participation Scale was used to measure engagement. Clinical predictors were measured using the Functional Independence Measure, National Institutes of Health Stroke Scale, Repeatable Battery for the Assessment of Neuropsychological Status, selected subtests of the Delis-Kaplan Executive Function System, Patient Health Questionnaire-9, and Chedoke McMaster Stroke Assessment. Simple logistic regression identified individual clinical predictors associated with engagement. Hierarchical logistic regression identified the strongest predictors of engagement. Results: Impairments in executive functions [mean D-KEFS, odds ratio (OR)=4.062; 95% confidence interval (CI)=.866, 19.051], impairments in visuospatial skills (RBANS Visuospatial Index Score, OR=3.940; 95% CI=1.317, 11.785), impairments in mood (Patient Health Questionnaire-9, OR=2.059, 95% CI=.953, 4.449), and male gender (OR=2.474; 95% CI=1.145, 5.374) predicted levels of engagement in inpatient rehabilitation after controlling for study intervention group, baseline stroke severity, and baseline disability. Conclusions: Executive functions, visuospatial skills, mood, and gender distinguished individuals with high or low engagement in inpatient rehabilitation following stroke. Further studies should examine additional factors that may influence engagement (therapist-client relationship, treatment expectancy). (JINS, 2018, 24, 572–583)
Background: Children with abdominal pain in the emergency department (ED) are at particular risk of suboptimal analgesia due to fears of missing appendicitis and absent guidelines. Many still experience pain at discharge. Acetaminophen is the most commonly used analgesic and efficacy of hyoscine butylbromide (HBB) is supported by adult evidence. However, no evidence exists for either agent in children with abdominal pain. Objective: To determine if HBB is superior to acetaminophen for abdominal pain in children. Methods: We will consecutively recruit children 8-17 years presenting to the ED with presumed non-surgical abdominal pain rated >4/10 on the Faces Pain Scale – Revised (FPS-R) and described as colicky, excluding:-Suspected appendicitis or bowel obstruction-Anticholinergic, analgesic, or antispasmodic <12 hours-Peritoneal inflammation-Unable to swallow pills-Hypersensitivity to either intervention-Medically unstable-Previous bowel obstruction, abdominal surgery, myasthenia gravis, liver disease, glaucoma, or recent abdominal trauma (<48 hours)-Toxin ingestion (<24 hours)-Vomiting-Pregnancy Randomization and allocation concealment will be pharmacy-controlled and performed using a computerized random number generator and sequentially numbered, opaque, sealed envelopes, respectively. The physician, research assistant, nurse, and participant will be blinded. Due to perceptible differences, participants will be randomized in a double-dummy approach to:-HBB 10 mg tablet + acetaminophen placebo OR-Acetaminophen 15 mg/kg liquid (maximum 975 mg) + HBB placebo. The primary outcome will be the difference from baseline on the FPS-R at 120 minutes, reflecting HBB’s time to peak plasma concentration. The FPS-R has been validated in children >five years. Secondary outcomes include:-Pain scores at 15, 30, 45, 60, 80, 100, and 120 minutes post-intervention (FPS-R and 100 mm visual analog scale)-Discharge pain score-Rescue analgesia-Time to achieve a 20% reduction in pain-Adverse effects-Recidivism <48 hours-Missed surgical diagnoses (National Ambulatory Care Reporting System (NACRS) database)-Caregiver satisfaction (five-item Likert scale). Using the intention to treat principle, ordinal, ratio, and categorical data will be analyzed using the Mann-Whitney, paired t-test, and Pearson’s chi-square, respectively and summarized using 95% confidence intervals. Assuming a standard deviation of 2 faces, 83 children per group will be required to detect a 1-face difference at 5% significance with 90% power. Increasing by 20% equals 100 participants per group. P values <0.05 will be considered significant. An institutional audit revealed 380 eligible patients per year during research assistant availability. Given a 30% refusal rate, we expect five participants enrolled per week for 40 weeks. Importance: Our findings will guide evidence-based analgesic choices for children with non-surgical abdominal pain in the ED.
Evidence exists that analgesics are underutilized, delayed, and insufficiently dosed for emergency department (ED) patients with acute abdominal pain. For physicians practicing in a Canadian paediatric ED setting, we (1) explored theoretical practice variation in the provision of analgesia to children with acute abdominal pain; (2) identified reasons for withholding analgesia; and (3) evaluated the relationship between providing analgesia and surgical consultation.
Physician members of Paediatric Emergency Research Canada (PERC) were prospectively surveyed and presented with three scenarios of undifferentiated acute abdominal pain to assess management. A modified Dillman’s Tailored Design method was used to distribute the survey from June to July 2014.
Overall response rate was 74.5% (149/200); 51.7% of respondents were female and mean age was 44 (SD 8.4) years. The reported rates of providing analgesia for case scenarios representative of renal colic, appendicitis, and intussusception, were 100%, 92.1%, and 83.4%, respectively, while rates of providing intravenous opioids were 85.2%, 58.6%, and 12.4%, respectively. In all 60 responses where the respondent indicated they would obtain a surgical consultation, analgesia would be provided. In the 35 responses where analgesia would be withheld, 21 (60%) believed pain was not severe enough, while 5 (14.3%) indicated it would obscure a surgical condition.
Pediatric emergency physicians self-reported rates of providing analgesia for acute abdominal pain scenarios were higher than previously reported, and appeared unrelated to request for surgical consultation. However, an unwillingness to provide opioid analgesia, belief that analgesia can obscure a surgical condition, and failure to take self-reported pain at face value remain, suggesting that the need exists for further knowledge translation efforts.
This brief report provides an introduction to the topic of cognitive functioning in late-life depression (LLD). In addition to providing a review of the literature, we present a framework for understanding the heterogeneity of cognitive outcomes in this highly prevalent disorder. In addition, we discuss the relationship between LLD and dementia, and highlight the importance of regularly assessing cognitive functioning in older adults who present with depressive symptoms. If cognitive deficits are discovered during a neuropsychological assessment, we recommend referral to a geriatric psychiatrist or cognitive neurologist, for evaluation and treatment of the patient’s symptoms. (JINS, 2014, 20, 1–7)
Late-life depression may increase the risk of incident dementia, in
particular of Alzheimer's disease and vascular dementia.
To conduct a systematic review and meta-analysis to evaluate the risk of
incident all-cause dementia, Alzheimer's disease and vascular dementia in
individuals with late-life depression in population-based prospective
A total of 23 studies were included in the meta-analysis. We used the
generic inverse variance method with a random-effects model to calculate
the pooled risk of dementia, Alzheimer's disease and vascular dementia in
older adults with late-life depression.
Late-life depression was associated with a significant risk of all-cause
dementia (1.85, 95% CI 1.67-2.04, P< 0.001), Alzheimer's disease
(1.65, 95% CI 1.42-1.92, P<0.001) and vascular dementia (2.52, 95% CI
1.77-3.59, P<0.001). Subgroup analysis, based on five studies, showed
that the risk of vascular dementia was significantly higher than for
Alzheimer's disease (P=0.03).
Late-life depression is associated with an increased risk for all-cause
dementia, vascular dementia and Alzheimer's disease. The present results
suggest that it will be valuable to design clinical trials to investigate
the effect of late-life depression prevention on risk of dementia, in
particular vascular dementia and Alzheimer's disease.
Many states are adopting economic education standards for the K-12 curriculum, mandating economic education courses in rural and urban schools. We examine economic education outcomes for rural and urban students using test scores gathered during a national high school academic competition and by estimating a production function for economic education. We find only limited differences between the education production function in urban and rural settings and lower average scores for rural students. To close this gap, results suggest that rural schools should place economic content in the senior-year curriculum and provide teachers with increased postgraduate training in economics.
While bipolar disorder (BD) is a leading cause of disability, and an important contributor to disability in BD is cognitive impairment, there is little systematic research on the longitudinal course of cognitive function and instrumental activities of daily living (IADLs) in late-life. In this report, we characterize the 2-year course of cognitive function and IADLs in older adults with BD.
We recruited non-demented individuals 50 years and older with BD I or BD II (n = 47) from out-patient clinics or treatment studies at the University of Pittsburgh. Comparator subjects (‘controls’) were 22 individuals of comparable age and education with no psychiatric or neurologic history, but similar levels of cardiovascular disease. We assessed cognitive function and IADLs at baseline, 1- and 2-year time-points. The neuropsychological evaluation comprised 21 well-established and validated tests assessing multiple cognitive domains. We assessed IADLs using a criterion-referenced, performance-based instrument. We employed repeated-measures mixed-effects linear models to examine trajectory of cognitive function. We employed non-parametric tests for analysis of IADLs.
The BD group displayed worse cognitive function in all domains and worse IADL performance than the comparator group at baseline and over follow-up. Global cognitive function and IADLs were correlated at all time-points. The BD group did not exhibit accelerated cognitive decline over 2 years.
Over 2 years, cognitive impairment and associated functional disability of older adults with BD appear to be due to long-standing neuroprogressive processes compounded by normal cognitive aging rather than accelerated cognitive loss in old age.
Generalised anxiety disorder (GAD) in older adults is associated with
We examined neuropsychological functioning in older adults with GAD in
comparison with psychiatrically healthy older adults at baseline, and we
examined changes following a 12-week placebo-controlled trial of
A total of 160 participants without dementia aged ⩾60 with current GAD
and 37 individuals in a comparison group without psychiatric history
underwent neuropsychological assessment. Of these, 129 participants with
GAD were reassessed post-treatment (trial registration: NCT00105586).
The participants with GAD performed worse than the comparison group in
information processing speed, working memory, inhibition, problem-solving
(including concept formation and mental flexibility) and immediate and
delayed memory. Neuropsychological functioning was correlated with
everyday functioning. After treatment, those with low cognitive scores
experienced working memory, delayed memory and visuospatial ability
improvement and those who reported clinical improvement in anxiety
exhibited improvement in the ability to engage inhibition and episodic
recall. These improvements were modest and of similar magnitude in both
Generalised anxiety disorder in older adults is associated with
neuropsychological impairments, which are associated with functional
impairment. Those with GAD who either have a low cognitive performance or
report clinical improvement in anxiety post-treatment, show improvement
in multiple cognitive domains. These findings underscore the importance
of treatments that aid cognition as well as anxiety symptoms.
The ultimate aim of (economic) policy is to enhance social welfare. In an ideal world with perfect competition, no externalities and transaction costs, and with a perfect distribution of property rights, the optimal path of social welfare is reached automatically when all individuals maximise their own welfare. There is no need for coordination by the government since the market mechanism will do the job. However, the real world is not ideal. Various externalities, the provision of public goods and problems of distribution require government intervention. The discipline of public economics provides the theoretical foundation and practical solutions as to how to deal with problems of market failure and redistribution of income and wealth. Policy prescriptions on the most efficient ways for governments to intervene and solve the coordination problem at the macro level are widely discussed in the literature. Moreover, the problems of government failure, and of politicians and civil servants seeking to serve their own interests instead of the public interest of enhancing social welfare, are also subject of much academic debate.
However, the (economic) literature has paid far less attention to the way the process of policy preparation is organised. In democratic societies, the final step for policy measures to be implemented is that they are legitimised according to the existent democratic rules. However, before policy measures obtain parliamentary approval, a long and often winding road has to be followed to move from the first ideas about the policy measures to their final formulation.
Of all the Celtic countries, Scotland has lacked the kind of scholarly attention that has been lavished fruitfully on Wales, Ireland, Cornwall and Brittany. And yet of all of them, Scotland offers the widest range of interfaces with broader work on the cult of saints. The papers presented here cover this territory very effectively.... [the book] brings together excellent studies that successfully explore the wide ramifications of the topic. Anyone with an interest in saints' cults will want this book. DAUVIT BROUN, Professor of Scottish History, University of Glasgow. This volume examines the phenomena of the cult of saints and Marian devotion as they were manifested in Scotland, ranging from the early medieval period to the sixteenth century. It combines general surveys of the development of the study of saints in the early and later middle ages with more focused articles on particular subjects, including St Waltheof of Melrose, the obscure early medieval origins of the cult of St Munnu, the short-lived martyr cult of David, duke of Rothsay, and the Scottish saints included in the greatest liturgical compendium produced in late medieval Scotland, the Aberdeen breviary. The way in which Marian devotion permeated late medieval Scottish society is discussed in terms of the church dedications of the twelfth and thirteenth-century aristocracy, the ecclesiastical landscape of Perth, the depiction of Mary in Gaelic poetry, and the pervasive influence of the familial bond between holy mother and son in representations of the Scottish royal family. Dr Steve Boardman is Reader in History, University of Edinburgh; Eila Williamson gained her PhD from the University of Glasgow. Contributors: Helen Birkett, Steve Boardman, Rachel Butter, Thomas Owen Clancy, David Ditchburn, Audrey-Beth Fitch, Mark A. Hall, Matthew H. Hammond, Sim Innes, Alan Macquarrie
In this chapter, the focus is primarily on the problems that beset investigating saints' cults in the early medieval period, something approached also in Rachel Butter's incisive case-study of St Munnu. The Survey of Dedications to Saints in Medieval Scotland is one of the most welcome developments in such investigations. First, it will help us understand the dynamism and evolution of saints' cults during the later medieval period, a period for which there remains a great deal of work to do, and much headway to be gained in refining and opening out our understanding of medieval Scottish piety and the nexus between society and religion. Second, and more importantly for this contribution, it will help to clarify for us what we do and do not know about the later medieval position of the cult of those saints already present in the Scottish landscape in the period before the twelfth century. It has become increasingly apparent in recent studies that no real progress can be made in our understanding of early medieval saints' cults without a firm grasp of the nature of the later medieval evidence for those cults. This is especially so, given the paucity of clear documentation cited for the likes of church dedications or fair days by key secondary sources like Mackinlay's Ancient Church Dedications and Watson's Celtic Place-Names of Scotland. This chapter primarily addresses the evidence provided by one source which has had to remain largely outwith the remit of the Survey: place-name evidence.
In 1968 The Innes Review published an article by David McRoberts which was (to use a word often overused in recent years) seminal. Its influence is visible in much, indeed in almost everything, that has been written since 1968 about the Church and about religion in later medieval Scotland. The thesis which it presented was relatively straightforward. McRoberts argued that the fifteenth century witnessed a new and what he called ‘nationalist’ trend in Scottish religious observation. There were several dimensions to this development – but it was especially apparent, McRoberts argued, in the veneration of saints. Before the fifteenth century the Church had neglected Scotland's early saints; thereafter leading clergymen began to look anew at these forgotten worthies. In the earlier part of the century Prior James Haldenstone of St Andrews had coordinated a campaign to have St Duthac officially canonised. Elsewhere there were efforts to relocate the relics and to promote the cults of St Kentigern (at Glasgow and Culross), St Ninian (at Whithorn) and St Triduana (at Restalrig). We find the chronicler Walter Bower lauding St Columba and Archbishop Schevez of St Andrews mounting a search for the relics of St Palladius. This ‘devotional nationalism’ reached its culmination, according to McRoberts, in the early sixteenth century with the work of Bishop William Elphinstone and a team of collaborators in Old Aberdeen, who produced a new martyrology and a new breviary.
Munnu, or Fintan Munnu, as he is sometimes called in Scotland, is an apparently straightforward saint, with an eighth-century vita, an obit in the Annals of Ulster, an appearance in Adomnán's Vita Columbae, and a name – Mun or Mund – which appears in a distinctive form in place-names in Scotland: four Kilmuns in Argyll, and an Eilean Munde near Ballachulish in Lochaber. He is intriguing too in the survival of traces of his cult in fifteenth-century references to a keeper of his crozier, and in the surname Mac Gille Mund, evident in Argyll at least into the seventeenth century.
This cheerful opening may sound like a prelude to the cruel news that in fact Munnu is not straightforward at all – that his obit is unreliable, that the person in Vita Columbae is someone else altogether, and that Kilmun may commemorate another saint. I will indeed flag up some potential problems towards the end of this chapter but for now I am going to treat Munnu as if he were a nice simple saint, uncontaminated by overlap or confusion with other saints. And I treat his strange double name – Fintan Munnu – as a helpful aid in our attempts to track his cult. This name derives from the common name Fintan, of which there were many bearers,5 followed by an affectionate form of the same name, arrived at thus: Fintan > *Mo Finn (‘my Finn’ where the f is lenited and therefore silent) > Mun > Munnu.