To save content items to your account,
please confirm that you agree to abide by our usage policies.
If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account.
Find out more about saving content to .
To save content items to your Kindle, first ensure firstname.lastname@example.org
is added to your Approved Personal Document E-mail List under your Personal Document Settings
on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part
of your Kindle email address below.
Find out more about saving to your Kindle.
Note you can select to save to either the @free.kindle.com or @kindle.com variations.
‘@free.kindle.com’ emails are free but can only be saved to your device when it is connected to wi-fi.
‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.
The concept of “decolonisation” has gradually evolved within higher education, and can be defined as seeking to discern how historical systems of discrimination have shaped the networks around us, and how to adjust to the perspectives of those who have been oppressed and minoritised by these systems. Our aim was to assess what gaps there are in the Edinburgh Medical School psychiatry curriculum, in order that this might inform our next steps in “decolonising” the curriculum.
We reviewed all the teaching materials used for teaching Year 5 Psychiatry at the University of Edinburgh (n = 101). We made a count of the number of people or cases in each resource and the diversity of examples used. We subsequently examined each resource to see if it touched on each of six key areas considered to be representative of a “decolonising” effort. These were the assignment of gender only where necessary, cultural/religious differences, historical context, health inequalities, the patient-doctor relationship and global topics.
Of the resources where each of the criteria were applicable, 18% only assigned gender where necessary or left gender neutral, 4.35% addressed cultural or religious differences, 5.8% discussed the historical context, 4.35% tackled health inequalities, 1.45% raised the doctor-patient relationship and none introduced global topics. Of all the resources that include a direct reference to a patient or case, only 5.41% were explicitly from a different ethnic group other than “white”.
Our results show that all the key areas can be improved on. Addressing these issues has not been a focus for the curriculum before now and our next steps will be to approach each topic in turn and consider how the key areas can be introduced. We are assembling a focus group of psychiatrists and medical students and have designed a survey for students who have completed their psychiatry block.
With time, we hope to cultivate an attitude amongst students and teachers of psychiatry at Edinburgh University that boldly confronts the historical development of our subject, acknowledges those who have suffered for it, picks up on what may be missing or misrepresented, and encourages critical analysis of research. Our teaching materials should include examples which explore stereotypes and challenge prejudices. By broadening our repertoire, confronting the darker parts of our history, listening to those with quieter voices, and paying attention to lived experience, we can foster a culture of teaching and learning which is open, flexible and humble.
During the early stages of the COVID-19 pandemic, individuals were asked to stay home and restrict outings to limit the spread of the virus. Physical isolation was particularly emphasized for older adults over the age of 60 who, because of their age and related medical conditions, were at increased risk of severe disease and death from the virus. This led to reduced spread of the virus but also to social and emotional health challenges for older adults. Protecting the physical health of older adults was of the utmost importance during the pandemic but supporting social and mental health must not be overlooked. This patient-oriented qualitative study involved 40 interviews with older adults, conducted in the early stages of the pandemic, followed by a thematic analysis. Three themes were derived from the findings: subverted life plan, emotional impacts, and creating a path forward. The findings from this study will help inform current physical and social distancing guidelines during the ongoing COVID-19 pandemic. Moreover, findings indicate that social and emotional challenges with ongoing physical and social isolation must be taken into consideration for future pandemics.
Hill (Twin Research and Human Genetics, Vol. 21, 2018, 84–88) presented a critique of our recently published paper in Cell Reports entitled ‘Large-Scale Cognitive GWAS Meta-Analysis Reveals Tissue-Specific Neural Expression and Potential Nootropic Drug Targets’ (Lam et al., Cell Reports, Vol. 21, 2017, 2597–2613). Specifically, Hill offered several interrelated comments suggesting potential problems with our use of a new analytic method called Multi-Trait Analysis of GWAS (MTAG) (Turley et al., Nature Genetics, Vol. 50, 2018, 229–237). In this brief article, we respond to each of these concerns. Using empirical data, we conclude that our MTAG results do not suffer from ‘inflation in the FDR [false discovery rate]’, as suggested by Hill (Twin Research and Human Genetics, Vol. 21, 2018, 84–88), and are not ‘more relevant to the genetic contributions to education than they are to the genetic contributions to intelligence’.
Scholars attribute the growth and decline of Classic period (AD 200–900) settlements in the semi-arid northern frontier zone of Mesoamerica to rainfall cycles that controlled the extent of arable land. However, there is little empirical evidence to support this claim. We present phytolith, organic carbon, and magnetic susceptibility analyses of a 4000-yr alluvial record of climate and human land use from the Malpaso Valley, the site of one such Classic frontier community. The earliest farming occupation is detected around 500 BC and appears related to a slight increase of aridity, similar to the level of the modern day valley. By AD 500, the valley's Classic period Mesoamerican settlements were founded under these same dry conditions, which continued into the Postclassic period. This indicates that the La Quemada occupation did not develop during a period of increased rainfall, but rather an arid phase. The most dramatic changes detected in the valley resulted from the erosion associated with Spanish Colonial grazing and deforestation that began in the 16th century. The landscape of the modern Malpaso Valley is thus primarily the product of a series of intense and rapid transformations that were concentrated within the last 400 yr.
To describe the characteristics and impact of Clostridium difficile infection (CDI) in a long-term acute-care hospital (LTACH).
Retrospective matched cohort study.
A 38-bed, urban, university-affiliated LTACH.
The characteristics of LTACH-onset CDI were assessed among patients hospitalized between July 2008 and October 2015. Patients with CDI were matched to concurrently hospitalized patients without a diagnosis of CDI. Severe CDI was defined as CDI with 2 or more of the following criteria: age ≥65 years, serum creatinine ≥2 mg/dL, or peripheral leukocyte count ≥20,000 cells/μL. A conditional Poisson regression model was developed to determine characteristics associated with a composite primary outcome of 30-day readmission to an acute-care hospital, or mortality.
The overall incidence of CDI was 21.4 cases per 10,000 patient days, with 27% of infections classified as severe. Patients with CDI had a mean age of 70 years (SD, 14 years), a mean Charlson comorbidity index of 3.6 (SD, 2.0), a median length of stay of 33 days (interquartile range [IQR], 24–45 days), and a median time between admission and CDI diagnosis of 16 days (IQR, 9–23 days). The most commonly prescribed antibiotic preceding a CDI diagnosis was a cephalosporin, with median duration of 8 days (IQR, 4–14 days). In multivariate analysis, CDI was not significantly associated with the primary outcome (relative risk, 0.97; 95% CI, 0.59–1.58).
Incidence of CDI in an urban, university-affiliated LTACH was high. Future research should focus on infection prevention measures to decrease the burden of CDI in this complex patient population.
Using data from The National Epidemiologic Survey on Alcohol and Related Conditions, the strength of social networks and the association of self-reported health among American Indians and Alaska Natives (AI/AN) and non-Hispanic Whites (NHW) were compared. Differences in social network–health relationships between AI/ANs and NHWs were also examined. For both groups, those with fewer network members were more likely to report fair or poor health than those with average or more network members, and persons with the fewest types of relationships had worse self-reported health than those with the average or very diverse types of relationships. Furthermore, small social networks were associated with much worse self-reported health in AI/ANs than in NHWs.
Long-term care facility (LTCF) residents are at increased risk of Clostridium difficile infection (CDI). However, little is known about the incidence, recurrence, and severity of CDI in LTCFs or the extent to which acute care exposure contributes to CDI in LTCFs. We describe the epidemiology of CDI in a cohort of LTCF residents in Monroe County, New York, where recent estimates suggest a CDI incidence in hospitals of 9.2 cases per 10,000 patient-days.
Population-based surveillance study.
Monroe County, New York.
LTCF residents with onset of CDI while in the LTCF or less than 4 calendar-days after hospital admission from the LTCF from January 1 through December 31, 2010.
We conducted surveillance for CDI in residents of 33 LTCFs. A CDI case was defined as a stool specimen positive for C. difficile obtained from a patient without a C. difficile-positive specimen in the previous 8 weeks; recurrence was defined as a stool specimen positive for C. difficile obtained between 2 and 8 weeks after the last C. difficile-positive stool specimen.
There were 425 LTCF-onset cases and 184 recurrences, which yielded an incidence of 2.3 cases per 10,000 resident-days (interquartile range [IQR], 1.2–3.3) and a recurrence rate of 1.0 case per 10,000 resident-days (IQR, 0.3–1.4). The cases occurred in 394 LTCF residents, and 52% of these residents developed CDI within 4 weeks after hospital discharge. Hospitalization for CDI occurred in 70 cases (16%). Of those cases that involved hospitalization for CDI, 70% were severe CDI, and 23% ended in death within 30 days after hospital admission.
CDI incidence in Monroe County LTCFs is one-fourth the incidence among hospitalized patients. Approximately 50% of LTCF-onset cases occurred more than 4 weeks after hospital discharge, which emphasizes that prevention of CDI transmission should go beyond acute care settings.
The ability to detect dementia of the Alzheimer type (DAT) in a community-dwelling sample of elderly individuals on the basis of neuropsychological test performance was examined. Three hundred sixty community-dwelling individuals were identified by neurological examination as having probable or possible Alzheimer’s disease, being at risk for Alzheimer’s disease, or having no cognitive impairment. A logistic model comprised of tests of verbal and nonverbal memory, mental flexibility, and confrontation naming correctly classified 82% of DAT subjects and 98% of normal elderly subjects. The logistic model classified 77% of subjects who were diagnosed as at risk for Alzheimer's disease as being cognitively normal. A cross-validation with a clinically based sample of subjects correctly classified 89% of DAT patients and 100% of normal control subjects. The results suggest that psychometric discrimination of dementia may be less accurate in community-dwelling populations than in clinically based samples. (JINS, 1995, I, 252–260.)
The function of motherese has become a pivotal issue in the language-learning literature. The current research takes the approach of asking whether the prosodic characteristics that are distinctive to motherese could play a special role in facilitating the acquisition of syntax. Hirsh-Pasek, Kemler Nelson, Jusczyk, Cassidy, Druss & Kennedy (1987) showed that infants aged 0;7–0;10 are sensitive to prosodic cues that would help them segment the speech stream into perceptual units that correspond to clauses. The present study shows that infants' sensitivity to segment-marking cues in ongoing speech holds for motherese but not for adult-directed speech. The finding is that, for motherese only, infants orient longer to speech that has been interrupted at clausal boundaries than to matched speech that has been interrupted at within-clause locations. This selective preference indicates that the prosodie qualities of motherese provide infants with cues to units of speech that correspond to grammatical units of language – a potentially fundamental contribution of motherese to the learning of syntax.
Infants' sensitivity to word units in fluent speech was examined by inserting 1 sec pauses either at boundaries between successive words (Coincident versions) or between syllables within words (Noncoincident versions). In Experiment 1, 24 11-month-olds listened significantly longer to the Coincident versions. In Experiment 2, 24 four-and-a-half-and 24 nine-month-olds did not exhibit the preference for the Coincident versions that the 11-month-olds showed. When the stimuli were low-pass filtered in Experiment 3, 24 11-month-olds showed no preference for the Coincident versions, suggesting they rely on more than prosodic cues. New stimulus materials in Experiment 4 indicated that responses by 24 11-month-olds to the Coincident and Noncoindent versions did not depend solely on prior familiarity with the targets. Two groups of 30 11-month-olds tested in Experiment 5 were as sensitive to boundaries for Strong/Weak words as for Weak/Strong words. Taken together, the results suggest that, by 11 months, infants are sensitive to word boundaries in fluent speech, and that this sensitivity depends on more than just prosodic information or prior knowledge of the words.
Sylvia Plath is arguably the best-known and most iconic poet of her generation. Try to imagine, for instance, a major Hollywood studio producing a film about any of her contemporaries, much less casting an A-list actor, Gwyneth Paltrow, in the feature role. This reputation rests largely on one volume of poetry, Ariel, and a novel, The Bell Jar, that, while very good, would not be nearly as well known, nor so often taught, if not for the incandescence of the poetry. Ariel had this tremendous impact for three interlocking reasons. One, it is extraordinary, unmistakably original poetry. Two, its psychological intensity remains palpable four decades after its shocking debut. Three, its publication followed the suicide of the poet, who was young, beautiful and married to another major poet of the era. There is no way to separate these elements. As brilliant as the poetry is, there has been a good deal of excellent poetry written in the past forty years that has not earned international celebrity for its authors. Moreover, it is important not to separate aesthetic achievement, psychological extremity and biographical scandal. It is precisely this convergence that struck a nerve with postwar readers.
Two studies investigated whether four-year-old children (12 in Experiment 1 with a mean age of 4;8 and 36 in Experiment 2 with a mean age of 4;7) invent names for new artifacts based on the objects' functions as opposed to their perceptual properties. Children informed about the intended functions of novel objects provided more name innovations that were clearly function-based than perception-based. This tendency was observed when children were shown the objects' functions, even if they were also given verbal descriptions of the objects' perceptual properties and parts. Only when ignorant of the objects' intended functions did children tend to use perceptual features to create substantial numbers of names. Accordingly, results from this name-innovation methodology converge with findings from some recent studies of lexical categorization suggesting that functional information is critical to how preschoolers extend artifact names. Children appear to appreciate an intimate relation between the functions of artifacts and how they are named.