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Information is central to the evolution of biological complexity, a physical system relying on a continuous supply of energy. Biology provides superb examples of the consequent Darwinian selection of mechanisms for efficient energy utilisation. Genetic information, underpinned by the Watson-Crick base-pairing rules is largely encoded by DNA, a molecule uniquely adapted to its roles in information storage and utilisation.This volume addresses two fundamental questions. Firstly, what properties of the molecule have enabled it to become the predominant genetic material in the biological world today and secondly, to what extent have the informational properties of the molecule contributed to the expansion of biological diversity and the stability of ecosystems. The author argues that bringing these two seemingly unrelated topics together enables Schrödinger's What is Life?, published before the structure of DNA was known, to be revisited and his ideas examined in the context of our current biological understanding.
The Tailored Activity Program (TAP) is an evidence-based occupational therapist-led intervention for people living with dementia and their care partners at home, developed in the USA. This study sought to understand its acceptability to people living with dementia, their care partners, and health professionals, and factors that might influence willingness to participate prior to its implementation in Australia.
This study used qualitative descriptive methods. Semi-structured interviews were conducted with people living with dementia in the community (n = 4), their care partners (n = 13), and health professionals (n = 12). People living with dementia were asked about health professionals coming to their home to help them engage in activities they enjoy, whereas care partners’ and health professionals’ perspectives of TAP were sought, after it was described to them. Interviews were conducted face-to-face or via telephone. All interviews were recorded and transcribed. Framework analysis was used to identify key themes.
Analysis identified four key themes labelled: (i) TAP sounds like a good idea; (ii) the importance of enjoyable activities; (iii) benefits for care partners; and (iv) weighing things up. Findings suggest the broad, conditional acceptability of TAP from care partners and health professionals, who also recognised challenges to its use. People living with dementia expressed willingness to receive help to continue engaging in enjoyable activities, if offered.
While TAP appeared generally acceptable, a number of barriers were identified that must be considered prior to, and during its implementation. This study may inform implementation of non-pharmacological interventions more broadly.
Hunting is a primary driver of biodiversity loss across South-east Asia. Within Cambodia, the use of wire snares to capture wildlife is a severe threat in protected areas but there have been few studies of the behaviour of hunters from local communities. Here, we combine the unmatched count technique with direct questioning to estimate the prevalence of hunting behaviours and wildlife consumption amongst 705 households living within Keo Seima Wildlife Sanctuary, Cambodia. We assessed respondents’ knowledge of rules, and their perceptions of patrols responsible for enforcing rules. Estimates of hunting behaviour were variable: results from the unmatched count technique were inconclusive, and direct questioning revealed 9% of households hunted, and 20% set snares around farms to prevent wildlife eating crops. Hunting with domestic dogs was the method most commonly used to catch wildlife (87% of households owned dogs). Wild meat was consumed by 84% of households, and was most frequently bought or caught, but also gifted. We detected a high awareness of conservation rules, but low awareness of punishments and penalties, with wildlife depletion, rather than the risk of being caught by patrols, causing the greatest reduction in hunting. Our findings demonstrate the challenges associated with reliably estimating rule-breaking behaviour and highlight the need to incorporate careful triangulation into study design.
Fibrinolysis is an acceptable treatment for acute ST-segment elevation myocardial infarction (STEMI) when primary percutaneous coronary intervention (PCI) cannot be performed within 120 minutes. The American Heart Association has recommended Emergency Medical Services (EMS) interventions such as prehospital fibrinolysis (PHF), prehospital electrocardiogram (ECG), and hospital bypass direct to PCI center. Nova Scotia, Canada has incorporated these interventions into a unique province-wide approach to STEMI care. A retrospective cohort analysis comparing the primary outcome of 30-day mortality for patients receiving either prehospital or emergency department (ED) fibrinolysis (EDF) to patients transported directly by EMS from community or regional ED for primary PCI was conducted.
This retrospective, population-based cohort study included all STEMI patients in Nova Scotia who survived to hospital admission from July 2011 through July 2013. Three provincial databases were used to collect demographic, 30-day mortality, hospital readmission, and rescue PCI data. The results were grouped and compared according to reperfusion strategy received: PHF, EDF, patients brought by ambulance via EMS direct to PCI (EMS to PCI), and ED to PCI (ED to PCI).
There were 1,071 STEMI patients included with 145 PHF, 606 EDF, 98 EMS to PCI, and 222 ED to PCI. There were no significant differences in 30-day mortality across groups (n, %): PHF 5(3); EDF 36(6); EHS to PCI <5(2); and ED to PCI 10(4); P = .28. There was no significant difference in patients receiving fibrinolysis who underwent rescue PCI.
Prehospital fibrinolysis incorporated into a province-wide approach to STEMI treatment is feasible with no observed difference in patient 30-day mortality outcomes observed.
L’histoire est répétition, celle de la psychiatrie n’y échappe pas. Après la scission historique d’avec la neurologie dans la seconde partie du XXe siècle et la Grande Guerre de la psychopathologie contre la neurobiologie dont cette séparation était un avatar, la discipline s’est progressivement rapprochée du médecine-chirurgie-obstétrique (MCO) pour finalement s’y réintégrer totalement en 2084. Les intérêts et limites de ce remariage sont multiples et seront exposés.
Le modèle de santé a radicalement changé. Peu se souviennent de l’enveloppe globale qui finançait les hôpitaux psychiatriques, tous connaissent la tarification à l’activité, les mouvements permanents imposés des tarifs qui surlignent les tendances et imposent réflexion et parfois adaptation. Le développement de l’ambulatoire et sa priorisation absolue (rappelons qu’il ne reste que 5 % des soins en hospitalier, tant en médecine qu’en chirurgie) ont considérablement modifié la manière d’appréhender la pathologie, de son évaluation à son traitement. La recherche des crédits ciblés, la déclinaison unifiée MCO des programmes régionaux de santé, l’attractivité de la discipline sur le territoire sont entre autre devenus le quotidien des chefs de pôle de psychiatrie et des directeurs délégués à leurs pôles.
Sur un plan scientifique, l’essor des connaissances sur tout le XXIe siècle, le développement prioritaire de la recherche et de l’innovation technique, l’essor des dispositifs implantables ont accéléré la fusion de la psychiatrie et du MCO, achevant sa mutation et son plein développement en médecine personnalisée, à partir des endophénotypes multiples que le DSM VII a intégrés avec le succès et le tollé que l’on sait dans ses schémas thérapeutiques.
Globalement, la pénétrance forte d’une représentation très médicalisée de la psychiatrie dans le grand public et les médias a considérablement fait évoluer les mentalités et les représentations de ce type de pathologies.
1. Inform European colleagues about current transformational changes in the organisation and delivery of care services in England to a vulnerable group of individuals with both intellectual impairment and multiple complex needs.
2. Compare and contrast English strategic direction /policy with European Union commitments
3. Stimulate debate on how such trends compare with the experiences of colleagues across Europe.
Examination of key English policy drivers including:
1. Valuing People Now (Intellectual Impairment).
2. New Horizons (Mental Health).
3. Putting People first (Social Care)
against current European Union commitments
Review of the implications of:
1. Demographic factors
2. Economic considerations
3. Diagnostic uncertainty
4. Scandals as catalysts
6. People being cared for away from their home areas
1. Cost, access and quality considerations are the priority areas under review.
2. Though care systems vary enormously across Europe, public expenditure as a share of Gross Domestic Product is unlikely to increase in the short to medium term and this irrefutable fact will challenge strategic intentions and citizens’ expectations, especially in England.
3. Both English and European Union strategic directions/policy contexts could be cynically viewed as being strong on principle and weak on implementation.
4. There is a profusion and confusion of existing terminology.
5. For individuals with intellectual impairment and complex needs and for their carers and families, what they all want is more choice, control and flexibility.
6. Affected individuals in England appear more satisfied with the strategic direction than are their carers and families.
The Psychiatrists are called to assess the level of risk in violent and sex offenders’ population. There are differing perceptions about formalising the severity and management of risk. The proponents of actuarial decision making propose that it is scientific and evidence based approach. The advocates of professional judgment however think that actuarial tools usually miss out on the interplay of compounding factors and can under or over estimate the level of risk.
To review consecutive patient assessments and qualitatively compare it with HCR-20 and RSVP tools for violent and sex offending patients.
To report the difference in outcome in the domains of overall severity of risk, risk formulation and clinical decision making for management of the risk in these patient groups.
We aim to compare twenty consecutive patients where professional judgment of the clinician determined the severity of the risk, risk formulation and management. We then aim to use the information available to check for any differences in these areas when HCR-20 and RSVP are employed.
The comparison and benefits of professional judgment and actuarial decision making are reported.
The professionals (providers) are being increasingly compelled by commissioners(purchasers) to evidence base their clinical decision making. The professional judgments are more likely to be challenged in the courts. People are easily impressed by decisions which are evidence based though they may have limited understanding of research environment and population studied.
Epilepsy is a common neurological condition affecting 1–2 percent of the population. At least 3,50,000 are affected in the UK, one quarter of whom have active epilepsy. There is higher representation of epilepsy in estimated 1.2 million learning disabled population in the UK. Rough estimates predict some 5 percent of such population are in institutional care; 30 percent requiring medical attention.
Lighthouse Healthcare provides inpatient tertiary care services to Learning Disability population with complex needs. A sizeable proportion of the inpatient population has complex and refractory epilepsy. As the services are provided at various hospital sites, we wanted to review the care of all the patients with epilepsy and compare it with national standards as set by the National Institute of Health and Clinical Excellence in England and Wales (NICE).
As most of the patients were already diagnosed elsewhere, we reviewed the medical records and compared the care with the standards envisaged in the NICE guidelines on the management of Epilepsies.
We contacted the Clinicians responsible for the care of all current inpatients and identified the cohort with epilepsy. We then reviewed the medical records for their conformity with NICE recommendations.
Besides missing records, we identified that there were major deficiencies in recording the breakthrough seizure activity as well as epilepsy review on yearly basis either by general practitioner or in specialist clinics.
The care provided to this vulnerable group falls short of standards expected in a secondary/tertiary care setting.
Distress intolerance has been suggested to be a maintaining factor in several mental health conditions. Distress tolerance skills training has been found to be beneficial in emotionally unstable personality disorder (EUPD) and post-traumatic stress disorder (PTSD). Short-term targeted interventions are increasingly being implemented in response to demand. This study investigates the efficacy of a distress tolerance brief psychological intervention (DT BPI) delivered by non-psychologists within an adult secondary care mental health service. Questionnaire data (pre and post) are reported from 43 participants who completed the intervention. Results suggest that the intervention was associated with significant improvements in distress tolerance, mood, anxiety and wellbeing. This indicates that a DT BPI can be effective when delivered by non-psychologists to real-world adult secondary care clients. The findings offer promising evidence that DT BPI could be a beneficial, cost-effective intervention and warrants further large-scale investigation.
Key learning aims
(1) To enhance practitioners’ awareness of distress intolerance as a potential maintaining factor and therefore treatment target.
(2) To outline a transdiagnostic distress tolerance brief psychological intervention.
(3) To illustrate the potential of this distress tolerance brief psychological intervention to produce positive reliable change with real-world clients when delivered by non-psychologists.
Subcutaneous adipose tissue (scAT) and peripheral blood mononuclear cells (PBMC) play a significant role in obesity-associated systemic low-grade inflammation. High-fat diet (HFD) is known to induce inflammatory changes in both scAT and PBMC. However, the time course of the effect of HFD on these systems is still unknown. The aim of the present study was to determine the time course of the effect of HFD on PBMC and scAT. New Zealand white rabbits were fed HFD for 5 or 10 weeks (i.e. HFD-5 and HFD-10) or regular chow (i.e. control (CNT)-5 and CNT-10). Thereafter, metabolic and inflammatory parameters of PBMC and scAT were quantified. HFD induced hyperfattyacidaemia in HFD-5 and HFD-10 groups, with the development of insulin resistance in HFD-10, while no changes were observed in scAT lipid metabolism and inflammatory status. HFD activated the inflammatory pathways in PBMC of HFD-5 group and induced modified autophagy in that of HFD-10. The rate of fat oxidation in PBMC was directly associated with the expression of inflammatory markers and tended to inversely associate with autophagosome formation markers in PBMC. HFD affected systemic substrate metabolism, and the metabolic, inflammatory and autophagy pathways in PBMC in the absence of metabolic and inflammatory changes in scAT. Dietary approaches or interventions to avert HFD-induced changes in PBMC could be essential to prevent metabolic and inflammatory complications of obesity and promote healthier living.
This article uses a 1741 testimonial document from Kol (present-day Aligarh) to explore the workings of petitions in the local politics of the late Mughal empire. I suggest that even solitary documents such as this can be read as artefacts of the continuing processes of local politics which operated in excess of the administrative logic of the Mughal state. After surveying the place of petitions in the Mughal apparatus of justice from an administrative perspective, I examine the story of a vanished artisan named Hira to demonstrate that even scattered documents from the Mughal archive can reveal traces of the larger political processes of which a petition might be a single example. In this light, I demonstrate how the testimonial at hand can illuminate the everyday workings of the social and political order of the locality, and its relationship with larger structures of ideology and state power in an era of political decentralization.
Cows have been the subject of political petitioning in South Asia for over a hundred years. This article examines the changing relationship between communities and the state in India through the transformation of petitioning practices—from ‘monster’ petitions, to postcard campaigns and constitutional writs—by the proponents and opponents of the cow protection movement from the late nineteenth century through to the first decades of independence. The article shows that, instead of disciplining and formalizing popular politics, petitioning provides channels for mobilization and disruption. As Hindus and Muslims engaged in competitive petitioning to rally a public, persuade the executive, or litigate through the courts, the question of cow slaughter was recast from one of community representation to religious belief, to property rights, to federalism, and, finally, questions of national economic development. In the absence of representative government in colonial India, Hindus for cow protection generated massive petitions which argued that they represented popular democratic will. Despite the lack of a constitution, Muslim petitioners sought to establish a judicially enforceable framework to protect their right to cow slaughter. Independence, which brought both democracy and a written constitution, caused a fundamental break with older claims and forms of petitioning, and led to both Hindus and Muslims seeking to settle the debate through writ petitions before constitutional courts.
This article explores the role of Indian petitioning in the process of consolidating British power after the East India Company's military conquest of Bengal in the late eighteenth century. The presentation of written petitions (often termed ‘arzi in Persian) was a pervasive form of state-subject interaction in early modern South Asia that carried over, in modified forms, into the colonial era. The article examines the varied uses of petitioning as a technology of colonial state-formation that worked to establish the East India Company's headquarters in Calcutta as the political capital of Bengal and the Company as a sovereign source of authority and justice. It also shows how petitioning became a site of anxiety for both colonial rulers and Indian subjects, as British officials struggled to respond to a mass of Indian ‘complaints’ and to satisfy the expectations and norms of justice expressed by petitioners. It suggests that British rulers tried to defuse the perceived political threat of Indian petitioning by redirecting petitioners into the newly regulated spaces of an emergent colonial judiciary.
In recent years, petitioning cultures have attracted scholarly interest because they are seen as germane to the infrastructure of political communication and modern associative life. Using materials from early colonial Madras, this article discloses a trajectory of the appeal which is different from its conventional place in the social theory of political communication. Colonial petitions carried with them the idea of law as equity through which a paternalist government sought to shape a consenting subject, even as this sense of equity was layered by other meanings of justice. In this sense petitions reworked and exceeded the idioms of imperial law and justice. Thus two aspects of the colonial petition are the focus of this article: its genealogies in the institutional history of the early modern corporation that transmitted notions of law as equity, and the recursive and heteroglossic nature of the language of appeal that enabled this text-form to be an enduring site for refashioning terms of address.
The historiography on colonial petitioning has primarily construed it as an authorized ritual of supplication designed to affirm and reproduce established power relations. This article restores to the analysis of the petition its status as a potential ‘event’ that could exceed its documentary confines and generate new communities of action. Focusing specifically on colonial Bombay, circa 1889–1914, it highlights three ways in which petitioning marked a rupture in the relations between rulers and ruled, and heralded significant shifts in the local constructions of state and society. First, the article shows how Bombay's Indian residents deployed the petitioning process to contest the unprecedented degree of state intervention in their quotidian lives following an extraordinary civic crisis that engulfed the city in the last decade of the Victorian era. Secondly, the article contends that the petitions that ordinary Indians in Bombay submitted to the different agencies of urban government point to a more complex set of orientations to the colonial state than has been acknowledged by scholars. Thirdly, the article argues that by the end of the nineteenth century, collective petitioning in colonial Bombay had become embedded in forms of political action with which it is conventionally regarded as being incompatible.
In a political culture that experiences inordinately high levels of petitioning, what makes for a successful petition? This article studies petitions that have been efficacious in their appeals to capture or kill big cats in Himalayan India. The rates of success for any appeal against big cats are low in contemporary India, given the stringent legal regime that is geared almost exclusively towards the protection of the charismatic and endangered big cats as well as the hegemonic position occupied by wildlife conservationism. Furthermore, not only is it difficult to petition against cossetted big cats, but it is also not an easy task for any petition to be heard and acquiesced to. Through an ethnography of efficacious petitions, this article makes three related interventions. First, and in the process of attending to the rarity of a handful of efficacious petitions, this article argues for expanding our conceptualization of what, in practice, a petition is. It does so by outlining the changing forms of efficacious petitions, which can range from a telephone call, a register entry, a WhatsApp message from a smart phone, to the more ‘traditional’ paper-based petition. Beyond its ever-evolving medium, this article demonstrates the criticality of folding petitioning into a wider process that involves planning, performance, perseverance, repetition, and the capacity to elicit visceral responses. Finally, through an ethnographic foregrounding of human-big cat interactions, it demonstrates how an acceptance and elaboration of animal agency enriches the study of politico-legal processes.
Bombay, the hub of Britain's Indian Ocean empire, hosted a ceaseless flow of humanity: sailors and lawyers, street performers and royal refugees. When fate set obstacles in their way, the residents of this teeming metropolis petitioned colonial officials, looking on them as patriarchal providers of last resort. These petitions, which this article terms ‘personal pleas’, adeptly braided different, often contradictory, idioms of late nineteenth- and early twentieth-century imperial governance, from stylized imitations of traditional authority to bureaucratic proceduralism. Their functional contribution to Raj governance, however, remains a puzzle since the vast majority of petitions were rejected. For the British, the steady flow of rejections threatened to unmask the disjuncture between the expectations and realities of Raj paternalism. As a result, colonial officials viewed personal pleas with a mixture of ridicule and concern. Yet, while unsettling for officials, personal pleas rarely spurred the collective politics associated with anti-colonial resistance. Thus, where other articles in this special issue focus on petitioning's functional contributions to the consolidation of state bureaucracies and the formation of new publics, this article traces the genre's more emotive dimensions. Even as they failed to consolidate colonial discipline or resistance, personal pleas provided a vehicle for the airing of the lived contradictions and tensions of empire. They allowed rulers and subjects alike to fantasize about the possibility of a more benevolent order, and to vent their frustration when those fantasies crumbled in the face of imperial indifference.