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Few poets have captured the imagination of the world like Seamus Heaney. Recognized as one of the truly outstanding poets of our time, Heaney's work is both critically acclaimed and popular with the general reader. It is taught in classrooms across the globe and has been translated into more than twenty-seven languages. Presenting original research from an international field of scholars, Seamus Heaney in Context offers new pathways to explore the places, times and influences that made Heaney a poet. Drawing on newly available archival and print sources, these essays situate Heaney in a multitude of contexts that help readers navigate received ideas about his life and work. In mapping intersecting themes in the current terrain of Heaney criticism, this study also signposts new directions for understanding Heaney's poetry in future contexts.
This chapter maps the emerging conceptual terrain of posthumanism and its relevance for discourse studies, with a particular focus on sociolinguistics and applied linguistics work. Posthumanism is a label applied to a range of theoretical and methodological approaches across the humanities and social sciences that are calling into question dominant assumptions generated by Western Enlightenment thinking about the human by giving greater consideration to the role of material objects, animals and the environment in understanding the social world. Posthumanism thus considers the implications of the central role of materialism in our understandings of human agency, language, cognition and society. For discourse studies, a turn to posthumanism requires us to examine the role of discourse in how humans become entangled with the material world through their everyday embodied interactions with objects, artifacts, technologies, plants, animals, and the built and natural environment. Through embracing an activity-oriented perspective toward these human–nonhuman entanglements, the implications are that we must rethink modernist categorical boundaries between subject/object, human/nonhuman and society/nature, both within metadiscourses about these dichotomies and through a more microanalytic lens in the analysis of text and talk.
In a European, phase 3 study (SPD489-325), lisdexamfetamine dimesylate (LDX) and osmotic-release oral system methylphenidate (OROS-MPH) were more effective than placebo in improving core symptoms in children and adolescents with attention-deficit/hyperactivity disorder (ADHD).
Objectives and aims
To compare post hoc the efficacy of LDX and OROS-MPH in study SPD489-325.
This 7-week, randomized, double-blind, parallel-group, dose-optimized, placebo-controlled trial enrolled patients aged 6-17 years with ADHD of at least moderate severity. Patients were randomized (1:1:1) to receive a once-daily dose of LDX (30, 50, 70 mg/day), OROS-MPH (18, 36, 54 mg/day) or placebo. Efficacy was assessed using the ADHD Rating Scale version IV (ADHD-RS-IV) and the Clinical Global Impression-Improvement (CGI-I) scale. Endpoint was defined as the last ontherapy treatment visit with a valid assessment.
The full analysis set comprised 317 patients (LDX, n=104; placebo, n=106; OROS-MPH, n=107). The difference between LDX and OROS-MPH in least squares mean change (95% confidence interval [CI]) in ADHD-RS-IV total score from baseline to endpoint was statistically significant in favour of LDX (-5.6 [-8.4, -2.7]; p < 0.001; effect size, 0.541). The difference (LDX minus OROS-MPH) in the percentage of patients (95% CI) with an improved CGI-I score at endpoint was also statistically significant in favour of LDX (17.4 [5.0, 29.8]; p < 0.05).
This post hoc analysis indicated that LDX is significantly more effective than OROS-MPH in improving core symptoms and global functioning in children and adolescents with ADHD.
In a European, phase 3 study (SPD489-325), lisdexamfetamine dimesylate (LDX) was more effective than placebo in improving symptoms and global functioning in children and adolescents with attention-deficit/hyperactivity disorder (ADHD).
Objectives and aims
To evaluate the impact of age, sex and baseline disease severity on efficacy outcomes in SPD489- 325.
This 7-week, double-blind, parallel-group, dose-optimized study enrolled patients aged 6-17 years with ADHD. Patients were randomized (1:1:1) to once-daily LDX (30, 50 or 70mg/day), osmotic-release oral system methylphenidate (OROS-MPH; 18, 36 or 54mg/day) or placebo. Efficacy outcomes were analysed in patients dichotomized by age (6-12 years [n=229] or 13-17 years [n=88]), sex (male [n=255] or female [n=62]) and baseline ADHD Rating Scale version IV (ADHD-RSIV) total score (28-41 [n=161] or 42-54 [n=152]). Endpoint was the last on-treatment visit with a valid assessment.
At endpoint, differences (active-placebo) in least-squares mean changes from baseline in ADHD-RS-IV total scores were statistically significant in all age, sex and ADHD-RS-IV total score subgroups for LDX (p< 0.001; effect sizes, 1.68-2.26) and OROS-MPH (p< 0.01; effect sizes, 0.88-1.46). Proportions of patients with a Clinical Global Impressions-Improvement rating of 1 (very much improved) or 2 (much improved) were statistically significantly greater than placebo at endpoint in all subgroups receiving LDX (p< 0.01) and in all subgroups except females receiving OROS-MPH (p< 0.05).
LDX showed greater efficacy than placebo in children and adolescents with ADHD, regardless of their age, sex or baseline disease severity.
The number of older people choosing to relocate to retirement villages (RVs) is increasing rapidly. This choice is often a way to decrease social isolation while still living independently. Loneliness is a significant health issue and contributes to overall frailty, yet RV resident loneliness is poorly understood. Our aim is to describe the prevalence of loneliness and associated factors in a New Zealand RV population.
A resident survey was used to collect demographics, social engagement, loneliness, and function, as well as a comprehensive geriatric assessment (international Resident Assessment Instrument [interRAI]) as part of the “Older People in Retirement Villages Study.”
RVs, Auckland, New Zealand.
Participants included RV residents living in 33 RVs (n = 578).
Two types of recruitment: randomly sampled cohort (n = 217) and volunteer sample (n = 361). Independently associated factors for loneliness were determined through multiple logistic regression with odds ratios (ORs).
Of the participants, 420 (72.7%) were female, 353 (61.1%) lived alone, with the mean age of 81.3 years. InterRAI assessment loneliness (yes/no question) was 25.8% (n = 149), and the resident survey found that 37.4% (n = 216) feel lonely sometimes/often/always. Factors independently associated with interRAI loneliness included being widowed (adjusted OR 8.27; 95% confidence interval [CI] 4.15–16.48), being divorced/separated/never married (OR 4.76; 95% CI 2.15–10.54), poor/fair quality of life (OR 3.37; 95% CI 1.43–7.94), moving to an RV to gain more social connections (OR 1.55; 95% CI 0.99–2.43), and depression risk (medium risk: OR 2.58, 95% CI 1.53–4.35; high risk: OR 4.20, 95% CI 1.47–11.95).
A considerable proportion of older people living in RVs reported feelings of loneliness, particularly those who were without partners, at risk of depression and decreased quality of life and those who had moved into RVs to increase social connections. Early identification of factors for loneliness in RV residents could support interventions to improve quality of life and positively impact RV resident health and well-being.
There are many barriers to mental health care in the Black Community. These barriers lead to racial disparities in access to treatment and quality of life, along with inappropriate treatment and misdiagnosis in mental and physical health. These disparities directly lead to increased morbidity, mortality and poor mental health in the our communities. Many would question if Black people are not interested in mental health and don’t see it as a needed concern. This talk will address that all cultures are not the same and that there is a fundamental need to address communities on their terms and not make them conform into a "majority culture" approach and perception of mental health care, but rather focus on the individual patient and community needs for mental health care. Often psychiatrists and other mental health professionals are trained in a very academic scientific approach to identification and treatment of mental illness. Too often this model does not fit the needs of all patients due to it not taking into account ethnic differences in communication of mental health and desired outcomes of the patient. This often leads to a lack of understanding on with both sides, the mental health professional and the patient. Too often a patient may see the physician, be given a diagnosis, starts taking a prescription, but then not be able to explain what is their diagnosis, the name of the medication, what it is for, nor what is the medication supposed to do for them. This could lead to unexpected poor outcomes due to the lack of effective communication. This talk will attempt to explain the barriers of communication to the Black community while appreciating and supporting cultural nuance and effective communication. This is needed to help bring mental health to the community in a digestible way and to meet the communities needs on their level. To do this, psychiatry needs to shift it’s focus to understanding cultural characteristics, such as how Black patients may have different cultural needs and may benefit from a unique, customized approach to their mental health. There is a need for psychiatry to take into consideration the spiritual aspects of patients and how many focus not only on needing to improve themselves, but also on how their mental health and behavior are impacting their family and the community as a whole. The traditional model of interview, diagnosis with medication, and follow up for medication adjustment is not fitting all communities leading to the detriment of their mental health.
Psychoeducation for service users has been shown in several recent meta-analyses to improve adherence with treatment, decrease rehospitalization rates and improve various measures of quality of life. The 8-week EOLAS Programme for service users with schizophrenia or bipolar disorder is unique in being designed, co-facilitated and evaluated collaboratively by both clinician and peer representatives. EOLAS forms part of the service plan of the national Health Service in Ireland.
Aims and objectives
To evaluate the impact of the EOLAS programme on participants’ perceived knowledge, confidence, advocacy, recovery attitudes and hope.
Anonymised questionnaires were administered to participants before and after completion of the EOLAS Programme.
All survey participants were invited to attend for interview to examine qualitatively their experience of the programme. Interviews were recorded and subjected to thematic analysis.
Significant improvements (P < 0.05) were identified across each of the 5 domains examined (i.e. perceived knowledge, confidence, advocacy, recovery attitudes, hope). Expressed satisfaction with the programme was high (95%).
At interview, participants (n = 12) particularly valued:
– the opportunity to ask questions of the psychiatrist e.g. about medication;
– improving self-care skills e.g. monitoring early warning signs of relapse;
– co-facilitation by a peer, which provided extra credibility and inspired hope;
– sharing experiences with peers.
The EOLAS programme succeeds in meeting the needs of the participants across the target domains. This success depends on the unique collaboration between clinicians and peer experts on which EOLAS is based.
Disclosure of interest
The authors have not supplied their declaration of competing interest.
Involuntary admission and treatment is often a traumatic experience for patients and there is a wide variation in attitudes towards care even when patients are recovered.
The purpose of this large prospective study was to identify clinical predictors of attitudes towards care during involuntary admission.
Three hundred and ninety-one consecutively admitted involuntarily patients to three psychiatric inpatient units over a 30-month period were invited to participate in the study. Comprehensive assessments at admission and 3 months after discharge were attained including measures of symptoms, insight, functioning, attitudes towards involuntary admission and coercive experiences. Multiple linear regression modelling was used to determine the optimal explanatory variables for attitudes towards care.
Two hundred and sixty-three individuals participated at baseline and 156 (59%) successfully completed follow-up assessments. Individuals improved significantly over time clinically and in their attitudes towards their care. At baseline greater insight (P < 0.001) and less symptoms (P = 0.02) were associated with more positive attitudes towards care as was older age (P = 0.001). At follow-up, greater insight (P < 0.001), less symptoms (P = 0.02) and being older (P = 0.04) were associated with more positive attitudes towards care. More positive attitudes towards care at follow-up were associated with greater improvements in insight over time (P < 0.001) and having a diagnosis of an affective psychosis (P = 0.0009).
The best predictors of positive attitudes towards care during and after involuntary admission are illness related factors, such as levels of insight and improvement in insight, rather than service or legislation related factors, such as the use of coercive measures, seclusion and restraint.
Disclosure of interest
The authors have not supplied their declaration of competing interest.
The Mental Health Act 2001 provides a legal framework for the involuntary admission and treatment of individuals deemed to have a mental disorder to psychiatric units. The perspectives of people who have been detained are relatively poorly understood.
To develop a theoretical understanding of individual's experiences throughout the trajectory of their detention and to understand the psychological and social processes that individuals use to cope before, during and after detention.
Fifty individuals subject to detention across three psychiatric units consented to be interviewed three months after their detention. Using a semi-structured interview people recounted their experiences. Interviews were analysed using the principles underpinning Grounded Theory.
The theory ‘Preserving Control’ encapsulates individuals’ experiences and consists of three related themes: ‘Losing Control’, ‘Regaining Control’ and ‘Maintaining Control’. ‘Losing Control’ describes individuals’ experiences of losing their autonomy and liberty thought the process of detention and hospitalisation. ‘Regaining Control describes, the strategies individuals used in an attempted to restore their loss of autonomy and control. ‘Maintaining Control’ describes how individuals lived with the consequences of detention and contended with impact on discharge.
Whilst a large variation existed in relation to the subjective experience of being detained, the characteristic process that individuals tend to experience related to identifiable phases of preserving control in the face of this loss of autonomy. Findings from this study highlight the importance of more sensitive interactions support and information during and after the detention process.
Disclosure of interest
The authors have not supplied their declaration of competing interest.
This paper describes the perspectives of a service user academic and a psychiatric trainee in response to their engagement in service user supervision, now offered as part of our psychological medicine education, as a feature of an innovative service user-led, recovery and human rights focused, contact-based education programme. The supervision, being deliberately focused on exploring and addressing responsiveness to the traditionally underprivileged service user’s perspective, and hence vastly different to clinical supervision, was acknowledged by the trainee as being of distinct value, translating into changes in practice, particularly in terms of addressing power imbalances, enhancing communication with patients, supporting recovery and enabling supported decision-making. The main barrier to implementation of such changes was identified as being the lack of support of senior clinicians. The active support and enablement of trainees who want to share and apply new perspectives, models and approaches being advocated, including through current training, would likely be of benefit to all.
This is a tale of a 40-year relationship between a college programme, its staff and students, and the Isle of Rum National Nature Reserve (NNR). In 1972, the then Director of the Nature Conservancy Council for Scotland (NCCS), Dr John Morton Boyd, wrote to outdoor education staff at Moray House College of Education in Edinburgh, inviting them to bring students to an island that the Nature Conservancy had bought from the owner, Lady Monica Bullough, in 1957. The 26,000 acres of hills and bogs that comprise the Isle of Rum (or Rhum as it was then called) had been bought for the nation (at £1 per acre), and came with its own castle. Neville Crowther, a lecturer, botanist and field naturalist who taught on the one-term outdoor activities programme for teachers, accepted the invitation enthusiastically, and the first ever educational field course on the island took place in the spring of 1974. The fit was perfect: the mountains, wild-land and coast of the island provided opportunities for outdoor adventures such as mountaineering on the famous Rum Cuillin; the diverse habitats were ideal for field studies, and the landscape provided rich opportunities to discuss the cultural heritage and consequences of centuries of upland management for sheep-grazing and deer-stalking.
Chickenpox is caused by varicella-zoster-virus (VZV) and is highly contagious. Immigration detention settings are a high-risk environment for primary VZV transmission, with large, rapidly-changing populations in close quarters, and higher susceptibility among non-UK-born individuals. During outbreaks, operational challenges occur in detention settings because of high-turnover and the potential need to implement population movement restriction for prolonged periods. Between December 2017 and February 2018, four cases of chickenpox were notified amongst 799 detainees in an immigration removal centre (IRC). Microbiological investigations included case confirmation by vesicular fluid polymerase chain reaction, and VZV serology for susceptibility testing. Control measures involved movement restrictions, isolation of cases, quarantining and cohorting of non-immune contacts and extending VZV immunity testing to the wider detainee population to support outbreak management. Immunity was tested for 301/532 (57%) detainees, of whom 24 (8%) were non-immune. The level of non-immunity was lower than expected based on the existing literature on VZV seroprevalence in detained populations in England. Serology results identified non-immune contacts who could be cohorted and, due to the lack of isolation capacity, allowed the placement of cases with immune detainees. The widespread immunity testing of all detainees was proving challenging to sustain because it required significant resources and was having a severe impact on operational capacity and the ability to maintain core business activities at the IRC. Therefore, mathematical modelling was used to assess the impact of scaling back mass immunity testing. Modelling demonstrated that interrupting testing posed a risk of one additional case compared to continuing with testing. As such, the decision was made to stop testing, and the outbreak was successfully controlled without excessive strain on resources. Operational challenges generated learning for future outbreaks, with implications for a local and national policy on IRC staff occupational health requirements, and proposed reception screening of detainees for VZV immunity.
Constant strain rate nanoindentation hardness measurements at high sustained strain rates cannot be made in conventional nanoindentation testing systems using the commonly employed continuous stiffness measurement technique (CSM) because of the “plasticity error” recently reported by Merle et al. [Acta Mater.134, 167 (2017)]. To circumvent this problem, here we explore an alternative testing and analysis procedure based on quasi-static loading and an independent knowledge of the Young's modulus, which is easily obtained by standard nanoindentation testing. In theory, the method applies to any indentation strain rate, but in practice, an upper limit on the rate arises from hardware limitations in the testing system. The new methodology is developed and applied to measurements made with an iMicro nanoindenter (KLA, Inc.), in which strain rates up to 100 s−1 were successfully achieved. The origins of the hardware limitations are documented and discussed.
We propose that abstraction is an interpersonal process and serves a social function. Research on shared reality shows that in communication, people raise their level of abstraction in order to create a common understanding with their communication partner, which can subsequently distort their mental representation of the object of communication. This work demonstrates that, beyond building accurate models, abstraction also functions to build socially shared models – to create a shared reality.
Prevalence of type 2 diabetes mellitus has significantly increased in the last three decades and currently affects about 1 in 10 globally. A common therapeutic target for type 2 diabetes is α- glucosidase, an essential enzyme located at the brush border of the small intestinal epithelium. The inhibition of α-glucosidase results in a reduced digestion of carbohydrates and a decrease of postprandial blood glucose. Although, synthetic inhibitors are available in the market, these are usually associated with significant gastrointestinal side effects. In this study, natural inhibitors derived from edible brown algae are being investigated as an alternative.
Polysaccharide- and polyphenolic-enriched extracts from Ascophyllum nodosum and Fucus vesiculosus were characterized and screened for their inhibitory effects against α-glucosidase obtained from rat intestine using maltose, sucrose, and p-nitrophenyl (pNPG) as substrates. Acarbose was used as a synthetic inhibitor. Furthermore, enzyme kinetics and mechanism of inhibition of α- glucosidase were determined using linear and non-linear regression methods (GraphPad Prism ver. 6, GraphPad Software, La Jolla California USA).
All tested extracts showed a dose-dependent inhibitory effect against α-glucosidase. However, the type of inhibition varied between the extracts. Most importantly, the composition analysis showed that the seaweed extracts had different polysaccharide and phenolic contents, suggesting different mode of actions against α-glucosidase. The relation between chemical composition and inhibitory activity of the compounds are discussed.
In summary, the current study demonstrates the mechanisms in which different brown seaweed extracts with various composition effectively inhibit α-glucosidase. Therefore, this natural inhibitor can be considered as a potential candidate for the management of type 2 diabetes mellitus.
Cancer patients experience many diet and nutrition-related problems, which are often under-recognised and under-treated. Research suggests few healthcare professionals discuss dietary information with cancer patients. Consequently, patients may seek information from other sources. It is unknown what these information sources are or what types of advice patients obtain and follow. The aim of this study was to determine the source and type of diet information cancer patients obtain before their first dietetic assessment and the degree to which this is followed. This was a prospective, multi-center, cross-sectional observational study. Ethical approval was obtained for each centre. Consecutive cancer inpatients and outpatients were recruited for six months at seven tertiary centers. Patients were screened for eligibility. Inclusion criteria included solid tumour, over 18 years of age, new dietetic referral and ability to sign consent. Data collection was carried out by a dietitian during initial routine dietetic assessment. Participants were asked four questions about dietary advice since cancer diagnosis. To date, 74 participants (50% female) with a median age 60 (range 23–80) have been recruited. Forty percent reported weight loss of ≥ 5%. The median time from diagnosis to initial dietetic assessment was 3 months (range 0–242). Patients who obtained advice did so from several sources (median 2 sources per patient, range 0–6) prior to dietetic referral. In rank order these were; 1) family or friend (n = 31), 2) health professional (n = 24), 3) online forums or websites (n = 16) and 4) media (n = 14). Twenty-one (28%) had received no dietary advice. The most frequent advice obtained related to avoidance of certain foods; particularly dairy, meat and sugar. Fruit, vegetables, protein, juices and wholegrain were advised. Fifty-one percent followed the advice fully and 4% partially. Seven expressed disappointment at not having a dietetics referral earlier and identified the need for the hospital “to introduce good information early”. In conclusion, the majority of dietary and nutritional advice prior to dietetic referral came from friends, family, media and online forums and websites. Most advice related to the avoidance and/or promotion of particular foods. Cancer patients want dietary advice from dietitians at diagnosis to prevent unnecessary avoidance of certain foods and to reduce the risk of unintentional weight loss.