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The Neolithisation of Europe involved socio-economic and biological adaptations to new environments. The use of seaweed as livestock fodder, for example, was key to the introduction of animal husbandry to the Orkney archipelago, c. 3500 cal BC. Using stable isotope analysis of faunal remains from Skara Brae, this study provides new evidence for, and clarifies the chronology of, the adoption of seaweed consumption by sheep. The results show that sheep consumed moderate amounts of seaweed from the moment of their introduction to Orkney—a practice that facilitated the successful spread of the farming lifeways to the most remote areas of Europe.
To follow-up a cohort of older people who self-harmed, their carer, and general practitioner (GP) and examine their reflections on the self-harm, care experiences, and outcomes.
Qualitative in-depth interviews.
Two teaching hospitals and associated community services.
Twelve-month follow-up of participants aged 80 or older who self-harmed, their nominated carers, and GPs.
A geriatric psychiatrist gathered data through patient and carer interviews using a narrative inquiry approach and from medical records. Interviews were audio recorded and transcribed. N-VIVO facilitated data organization for thematic analysis. Questionnaires sent to the patient’s GP examined their perspectives and aspects of care relating to the self-harm.
Nineteen patients (63% baseline sample), 29 carers (90.6%), and 11 GPs (36.7%) were available at follow-up. Themes emerging from patients were “denial and secrets;” “endless suffering;” “more invalidation;” “being heard;” and “miserable in care.” Themes from carer interviews were “denial and secrets;” “patient’s persistent wish to die;” “abandonment by clinicians;” “unending burden for the carer;” and “distress regarding placement.” General practitioner themes were “the problem is fixed;” “the troops have arrived;” and “I understand.”
Factors contributing to self-harm persisted at follow-up. Positive and negative responses were identified in the older person’s system, highlighting areas for potential intervention. A conceptual framework for understanding self-harm in the very old was derived that emphasized the importance of understanding individual needs, the interpersonal context of the older person, and carer burden. Interventions should improve communication, facilitate shared understanding of perspectives, and provide support at all levels.
Childhood maltreatment (CM) plays an important role in the development of major depressive disorder (MDD). The aim of this study was to examine whether CM severity and type are associated with MDD-related brain alterations, and how they interact with sex and age.
Within the ENIGMA-MDD network, severity and subtypes of CM using the Childhood Trauma Questionnaire were assessed and structural magnetic resonance imaging data from patients with MDD and healthy controls were analyzed in a mega-analysis comprising a total of 3872 participants aged between 13 and 89 years. Cortical thickness and surface area were extracted at each site using FreeSurfer.
CM severity was associated with reduced cortical thickness in the banks of the superior temporal sulcus and supramarginal gyrus as well as with reduced surface area of the middle temporal lobe. Participants reporting both childhood neglect and abuse had a lower cortical thickness in the inferior parietal lobe, middle temporal lobe, and precuneus compared to participants not exposed to CM. In males only, regardless of diagnosis, CM severity was associated with higher cortical thickness of the rostral anterior cingulate cortex. Finally, a significant interaction between CM and age in predicting thickness was seen across several prefrontal, temporal, and temporo-parietal regions.
Severity and type of CM may impact cortical thickness and surface area. Importantly, CM may influence age-dependent brain maturation, particularly in regions related to the default mode network, perception, and theory of mind.
In France, drug assessment is performed by the Transparency Committee (TC) of the French National Authority for Health (HAS). It's based on two criteria: the clinical benefit (CB) for reimbursement recommendation and the clinical added value (CAV) serving the pricing decision. The CAV is rated on a 5-point scale, from I (major) to V (no CAV). A critical step in the CAV assessment is the identification of the clinically relevant comparators (CRC) serving the TC to recognize the appropriateness of the comparators chosen in the randomized controlled trials (RCT). The objective of this study is to investigate the comparator choice consequences on TC appraisals and pricing.
A retrospective, descriptive study included all oncology indications assessed by the TC between 2015 and 2017. Based on a pre-specified grid, items on the comparators were extracted from final TC's appraisals.
Among the 135 indications included, the assessed drugs had no CRC in 20% of cases. A RCT was submitted for 89 indications (66%) whose 67 (76%) were conducted versus a CRC. A CRC was identified by the TC for 70% of the 46 indications without RCT. An important/moderate CAV (II-III) was granted when there was a RCT versus a CRC in 70% of cases, versus 50% and 43% for minor (IV) and no CAV respectively. The public price was reduced by 13.5% in average compared to the claimed price without impact of the CAV level (n = 18).
In oncology, comparative data assessed by the TC met its expectations (RCT versus CRC) in a majority of cases. When there is no RCT or a comparison versus a non-relevant comparator the CAV appraisal is decreased. Surprisingly this study hasn't shown any impact of this decrease on the public price. A wider analysis in different medical areas would need to be performed to better investigate these results.
The Hegelian concept, with its all-encompassing power, epitomizes the kind of totality-oriented thinking that Levinas, a philosopher of genuine alterity, sharply criticizes. This paper investigates this antagonism by focusing on a notion that is pivotal for both authors, the notion of subjectivity. Hegel makes transcendence into an immanent dimension of the subject whereas Levinas conceives transcendence as the subject’s relation with radical exteriority. The decisive question is whether Levinas falls back into the failures of so-called ‘philosophies of reflection’ or whether the Hegelian dialectic of being and nothing relies on an un-condition for which it does not and indeed cannot account. The paper culminates in the thesis that Hegel and Levinas reverse the order of priority of the Good and the True. While Hegel conceives of the absolute as system of truth, for Levinas the ethical ‘failure’ of totalization constitutes a necessary condition for rationality.
Cognitive deficits are a well-established feature of bipolar disorders (BD), even during periods of euthymia, but risk factors associated with cognitive deficits in euthymic BD are still poorly understood. We aimed to validate classification criteria for the identification of clinically significant cognitive impairment, based on psychometric properties, to estimate the prevalence of neuropsychological deficits in euthymic BD, and identify risk factors for cognitive deficits using a multivariate approach.
We investigated neuropsychological performance in 476 euthymic patients with BD recruited via the French network of BD expert centres. We used a battery of tests, assessing five domains of cognition. Five criteria for the identification of neuropsychological impairment were tested based on their convergent and concurrent validity. Uni- and multivariate logistic regressions between cognitive impairment and several clinical and demographic variables were performed to identify risk factors for neuropsychological impairment in BD.
One cut-off had satisfactory psychometric properties and yielded a prevalence of 12.4% for cognitive deficits in euthymic BD. Antipsychotics use were associated with the presence of a cognitive deficit.
This is the first study to validate a criterion for clinically significant cognitive impairment in BD. We report a lower prevalence of cognitive impairment than previous studies, which may have overestimated its prevalence. Patients with euthymic BD and cognitive impairment may benefit from cognitive remediation.
The relationship between residual depressive symptoms, cognition and functioning in patients with euthymic bipolar disorder is a subject of debate.
To assess whether cognition mediates the association between residual depressive symptoms and functioning in patients with bipolar disorder who were euthymic.
We included 241 adults with euthymic bipolar disorder in a multicentre cross-sectional study. We used a battery of tests to assess six cognition domains. A path analysis was then used to perform a mediation analysis of the relationship between residual depressive symptoms, cognitive components and functioning.
Only verbal and working memory were significantly associated with better functioning. Residual depressive symptoms were associated with poorer functioning. No significant relationship was found between residual depressive symptoms and any cognitive component.
Cognition and residual depressive symptoms appear to be two independent sources of variation in the functioning of people with euthymic bipolar disorder.
Cantors made unparalleled contributions to the way time was understood and history was remembered in the medieval Latin West. The men and women who held this office in cathedrals and monasteries wereresponsible for calculating the date of Easter and the feasts dependent on it, for formulating liturgical celebrations season by season, managing the library and preparing manuscripts and other sources necessary to sustain the liturgical framework of time, and promoting the cults of saints. Crucially, their duties also often included committing the past to writing, from simple annals and chronicles to more fulsome histories, necrologies, and cartularies, thereby ensuring that towns, churches, families, and individuals could be commemorated for generations to come. The contributions hereseek to address the fundamental question of how the range of cantors' activities can help us to understand the many different ways in which the past was written and, in the liturgy, celebrated acrossthe middle ages. Cantors, as this volume makes clear, shaped the communal experience of the past in the Middle Ages; the essays are studies of constructions, both of the building blocks of time and ofthe people who made and performed them, in acts of ritual remembrance and in written records.
Contributors: Cara Aspesi, Alison I. Beach, Katie Ann-Marie Bugyis, Margot E. Fassler, David Ganz, James Grier, Paul Antony Hayward, A.B. Kraebel, Lori Kruckenberg, Rosamond McKitterick, Henry Parkes, Susan Rankin, C.C. Rozier, Sigbjoryn Olsen Sonnesyn, Teresa Webber, Lauren Whitnah,
‘History’, as it was understood by medieval Christians, was a broad concept with many meanings. It could be defined as a written record, compiled through processes inherited from classical Greek and Roman authors. But even when it proclaimed itself to be ‘factual’, the work of those who shaped the past in the Latin Middle Ages was different from that of their pagan ancestors. Although they often made claims about veracity, even when dealing with the miraculous, they did not ‘absolutize’ history (as de Lubac put it). Although they had a sense of universal history, time instead related to and unfolded within a framework conditioned by the Incarnation of the Word, and by the moral sense that this history-transforming event could impart to listeners and readers. The biblical orientation of history gave time a clear beginning and also predicted an apocalyptic end. But even as time moved relentlessly forward in this cosmic sense, the liturgy made it constantly spiral backward, rendering past sacred events present through ritual commemoration. Such liturgical celebration of time had many layers, mingled and arranged according to the calendar, with its varying and its fixed cycles of feasts, voiced through psalmody, readings from the Old and New Testaments and the lives of the saints.
How the past was known, both by individuals and within communities, varied from one specific local community to another, for the liturgy was ever changing, especially as new feasts, and feasts of new saints, were added to suit particular needs. Some knew about certain past events from what they read, as had long been the case, but in the Middle Ages many more knew about the past from various reenactments: ritual actions, dramatic productions, sermons and tales they heard about biblical characters and saints, encounters with art and architecture and from contact with shrines and relics.
Much of medieval history-making was thus memorial in nature, bringing the past forward, again and again, to recall its individual or communal significance. At the heart of the medieval Christian understanding of the past was a simple, foundational command from Christ: ‘Hoc facite in meam commemorationem’ [‘Do this in remembrance of me’] (Luke 22. 19).