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Cognitive impairment is strongly linked with persistent disability in people with mood disorders, but the factors that explain cognitive impairment in this population are unclear.
To estimate the total effect of (a) bipolar disorder and (b) major depression on cognitive function, and the magnitude of the effect that is explained by potentially modifiable intermediate factors.
Cross-sectional study using baseline data from the UK Biobank cohort. Participants were categorised as having bipolar disorder (n = 2709), major depression (n = 50 975) or no mood disorder (n = 102 931 and n = 105 284). The outcomes were computerised tests of reasoning, reaction time and memory. The potential mediators were cardiometabolic disease and psychotropic medication. Analyses were informed by graphical methods and controlled for confounding using regression, propensity score-based methods and G-computation.
Group differences of small magnitude were found on a visuospatial memory test. Z-score differences for the bipolar disorder group were in the range −0.23 to −0.17 (95% CI −0.39 to −0.03) across different estimation methods, and for the major depression group they were approximately −0.07 (95% CI −0.10 to −0.03). One-quarter of the effect was mediated via psychotropic medication in the bipolar disorder group (−0.05; 95% CI −0.09 to −0.01). No evidence was found for mediation via cardiometabolic disease.
In a large community-based sample in middle to early old age, bipolar disorder and depression were associated with lower visuospatial memory performance, in part potentially due to psychotropic medication use. Mood disorders and their treatments will have increasing importance for population cognitive health as the proportion of older adults continues to grow.
Declaration of interest
I.J.D. is a UK Biobank participant. J.P.P. is a member of the UK Biobank Steering Committee.
Objective: Post-stroke cognitive impairment is common, but mechanisms and risk factors are poorly understood. Frailty may be an important risk factor for cognitive impairment after stroke. We investigated the association between pre-stroke frailty and acute post-stoke cognition. Methods: We studied consecutively admitted acute stroke patients in a single urban teaching hospital during three recruitment waves between May 2016 and December 2017. Cognition was assessed using the Mini-Montreal Cognitive Assessment (min=0; max=12). A Frailty Index was used to generate frailty scores for each patient (min=0; max=100). Clinical and demographic information were collected, including pre-stroke cognition, delirium, and stroke-severity. We conducted univariate and multiple-linear regression analyses with covariates forced in (covariates included were: age, sex, stroke severity, stroke-type, pre-stroke cognitive impairment, delirium, previous stroke/transient ischemic attack) to investigate the association between pre-stroke frailty and post-stroke cognition. Results: Complete data were available for 154 stroke patients. Mean age was 68 years (SD=11; range=32–97); 93 (60%) were male. Median mini-Montreal Cognitive Assessment score was 8 (IQR=4–12). Mean Frailty Index score was 18 (SD=11). Pre-stroke cognitive impairment was apparent in 13/154 (8%) patients. Pre-stroke frailty was significantly associated with lower post-stroke cognition (Standardized-Beta=−0.40; p<0.001) and this association was independent of covariates (Unstandardized-Beta=−0.05; p=0.005). Additional significant variables in the multiple regression model were age (Unstandardized-Beta=−0.05; p=0.002), delirium (Unstandardized-Beta=−2.81; p<0.001), pre-stroke cognitive impairment (Unstandardized-Beta=−2.28; p=0.001), and stroke-severity (Unstandardized-Beta=−0.20; p<0.001). Conclusions: Pre-stroke frailty may be a moderator of post-stroke cognition, independent of other well-established post-stroke cognitive impairment risk factors. (JINS, 2019, 25, 501–506)
Crisis resolution teams (CRTs) offer brief, intensive home treatment for people experiencing mental health crisis. CRT implementation is highly variable; positive trial outcomes have not been reproduced in scaled-up CRT care.
To evaluate a 1-year programme to improve CRTs’ model fidelity in a non-masked, cluster-randomised trial (part of the Crisis team Optimisation and RElapse prevention (CORE) research programme, trial registration number: ISRCTN47185233).
Fifteen CRTs in England received an intervention, informed by the US Implementing Evidence-Based Practice project, involving support from a CRT facilitator, online implementation resources and regular team fidelity reviews. Ten control CRTs received no additional support. The primary outcome was patient satisfaction, measured by the Client Satisfaction Questionnaire (CSQ-8), completed by 15 patients per team at CRT discharge (n = 375). Secondary outcomes: CRT model fidelity, continuity of care, staff well-being, in-patient admissions and bed use and CRT readmissions were also evaluated.
All CRTs were retained in the trial. Median follow-up CSQ-8 score was 28 in each group: the adjusted average in the intervention group was higher than in the control group by 0.97 (95% CI −1.02 to 2.97) but this was not significant (P = 0.34). There were fewer in-patient admissions, lower in-patient bed use and better staff psychological health in intervention teams. Model fidelity rose in most intervention teams and was significantly higher than in control teams at follow-up. There were no significant effects for other outcomes.
The CRT service improvement programme did not achieve its primary aim of improving patient satisfaction. It showed some promise in improving CRT model fidelity and reducing acute in-patient admissions.
Metal–insulator–metal (MIM) resonant absorbers comprise a conducting ground plane, a dielectric of thickness t, and thin separated metal top-surface structures of dimension l. The fundamental resonance wavelength is predicted by an analytic standing-wave model based on t, l, and the dielectric refractive index spectrum. For the dielectrics SiO2, AlN, and TiO2, values for l of a few microns give fundamental resonances in the 8-12 μm long-wave infrared (LWIR) wavelength region. Agreement with theory is better for t/l exceeding 0.1. Harmonics at shorter wavelengths were already known, but we show that there are additional resonances in the far-infrared 20 - 50 μm wavelength range in MIM structures designed to have LWIR fundamental resonances. These new resonances are consistent with the model if far-IR dispersion features in the index spectrum are considered. LWIR fundamental absorptions are experimentally shown to be optimized for a ratio t/l of 0.1 to 0.3 for SiO2- and AlN-based MIM absorbers, respectively, with TiO2-based MIM optimized at an intermediate ratio.
Depression is a common post-stroke complication. Pre-stroke depression may be an important contributor, however the epidemiology of pre-stroke depression is poorly understood. Using systematic review and meta-analysis, we described the prevalence of pre-stroke depression and its association with post-stroke depression.
We searched multiple cross-disciplinary databases from inception to July 2017 and extracted data on the prevalence of pre-stroke depression and its association with post-stroke depression. We assessed the risk of bias (RoB) using validated tools. We described summary estimates of prevalence and summary odds ratio (OR) for association with post-stroke depression, using random-effects models. We performed subgroup analysis describing the effect of depression assessment method. We used a funnel plot to describe potential publication bias. The strength of evidence presented in this review was summarised via ‘GRADE’.
Of 11 884 studies identified, 29 were included (total participants n = 164 993). Pre-stroke depression pooled prevalence was 11.6% [95% confidence interval (CI) 9.2–14.7]; range: 0.4–24% (I2 95.8). Prevalence of pre-stroke depression varied by assessment method (p = 0.02) with clinical interview suggesting greater pre-stroke depression prevalence (~17%) than case-note review (9%) or self-report (11%). Pre-stroke depression was associated with increased odds of post-stroke depression; summary OR 3.0 (95% CI 2.3–4.0). All studies were judged to be at RoB: 59% of included studies had an uncertain RoB in stroke assessment; 83% had high or uncertain RoB for pre-stroke depression assessment. Funnel plot indicated no risk of publication bias. The strength of evidence based on GRADE was ‘very low’.
One in six stroke patients have had pre-stroke depression. Reported rates may be routinely underestimated due to limitations around assessment. Pre-stroke depression significantly increases odds of post-stroke depression.
Metal–insulator–metal (MIM) resonant absorbers comprise a conducting ground plane, a thin dielectric, and thin separated metal top-surface structures. The dielectric SiO2 strongly absorbs near 9 µm wavelength and has correspondingly strong long-wave-infrared (LWIR) dispersion for the refractive index. This dispersion results in multiple absorption resonances spanning the LWIR, which can enhance broad-band sensitivity for LWIR bolometers. Similar considerations apply to silicon nitride Si3N4. TiO2 and AlN have comparatively low dispersion and give simple single LWIR resonances. These dispersion-dependent features for infrared MIM devices are demonstrated by experiment, electrodynamic simulation, and an analytic model based on standing waves.
Background: People with relapsing remitting multiple sclerosis (PwRRMS) suffer disproportionate decrements in gait under dual-task conditions, when walking and a cognitive task are combined. There has been much less investigation of the impact of cognitive demands on balance. Objectives: This study investigated whether: (1) PwRRMS show disproportionate decrements in postural stability under dual-task conditions compared to healthy controls, and (2) dual-task decrements are associated with everyday dual-tasking difficulties. The impact of mood, fatigue, and disease severity on dual-tasking was also examined. Methods: A total of 34 PwRRMS and 34 matched controls completed cognitive (digit span) and balance (movement of center of pressure on Biosway on stable and unstable surfaces) tasks under single- and dual-task conditions. Everyday dual-tasking was measured using the Dual-Tasking Questionnaire. Mood was measured by the Hospital Anxiety & Depression Scale. Fatigue was measured via the Modified Fatigue Index Scale. Results: No differences in age, gender, years of education, estimated pre-morbid IQ, or baseline digit span between groups. Compared with controls, PwRRMS showed significantly greater decrement in postural stability under dual-task conditions on an unstable surface (p=.007), but not a stable surface (p=.679). Balance decrement scores were not correlated with everyday dual-tasking difficulties or fatigue. Stable surface balance decrement scores were significantly associated with levels of anxiety (rho=0.527; p=.001) and depression (rho=0.451; p=.007). Conclusions: RRMS causes dual-tasking difficulties, impacting balance under challenging conditions, which may contribute to increased risk of gait difficulties and falls. The relationship between anxiety/depression and dual-task decrement suggests that emotional factors may be contributing to dual-task difficulties. (JINS, 2018, 24, 247–258)
Although violence over Northern Ireland's constitutional position has largely subsided, the problem of sectarian animosity between sections of the Protestant Unionist British and Catholic Irish Nationalist population remains. One such area of communal contestation is attitudes to Protestant parades, organized mainly by the Orange Order. For many Protestants, Orange Order marches are legitimate cultural, religious, and political expressions of Protestant culture, loyalty to the British Crown and a pro-United Kingdom position. For many Catholics, the Orange Order is seen as a sectarian and anti-Catholic organization, which prohibits its members marrying Catholics or attending Catholic Church services. The Parades Commission was established two decades ago to adjudicate on Orange Order parading routes. Its decisions have sometimes involved re-routing marches away from Catholic areas and the inability to satisfy both sides has been followed by riots on several occasions at the annual height of the Protestant “marching season.” This article examines levels of support or antipathy toward Orange Order marching rights among Protestants and Catholics. Drawing upon evidence from the most extensive recent study of public opinion in Northern Ireland, the 2015 Economic and Social Research Council general election study, the piece tests the importance of demographic, religious, political, and geographical variables in conditioning attitudes towards Orange parades.
Davis translated three books by Michel Leiris: Brisées: Broken Branches (1989), a collection of occasional essays, and two parts of his fourpart autobiography, Rules of the Game: Scratches (1997a) and Scraps (1997b). As mentioned in the Introduction, Davis wondered if Leiris was the ‘real pinnacle’ of a translator's career (Davis 1999: 87), given the complexity of his style and its close ties to the sound and sense of French. This chapter explores how Davis’ translations of Leiris produce a dialogue between the two authors, focusing, because of its centrality in Leiris’ oeuvre, on Davis’ relationship with La Règle du jeu. Leiris wrote in many genres, from surrealist poetry to ethnography, but for many critics his most important works are in the field of autobiography.
I begin with analyses of Davis’ translations of Leiris. Her approach to his work is uniquely radical, as Davis broke norms of translational procedure in responding to an unorthodox, poetic text. The recreative form of translation she practises here suggests a productive dialogue between the translation and Davis’ stories, which is also suggested by two texts by Davis with an intertextual link to Leiris, ‘Swimming in Egypt: Dreams While Awake and Asleep’ (Davis 2007b: 35–44) and ‘To Reiterate’ (Davis 1997a: 83). The second section of this chapter argues that these texts position Leiris as a precursor and influence, and the final section reads La Règle du jeu in relation to Davis’ writing, focusing on how Davis and Leiris have an affinity in their privileging of what Roman Jakobson (1960: 356–8) calls the ‘poetic function’ above narrative development in their texts. The poetic function is where language brings attention to itself, ‘focus[ing] on the message [i.e. the verbal text] for its own sake’ (ibid.: 356). This is not only relevant to poetry, but to any verbal text that is self-reflexive, folding the reader's attention back onto the text and the formal construction of that text.
The first in-depth analysis of Lydia Davis's translations and writing.The Many Voices of Lydia Davis shows how translation, rewriting and intertextuality are central to the work of Lydia Davis, a major American writer, translator and essayist. Winner of the Man Booker International Prize 2013, Davis writes innovative short stories that question the boundaries of the genre. She is also an important translator of French writers such as Maurice Blanchot, Michel Leiris, Marcel Proust and Gustave Flaubert. Translation and writing go hand-in-hand in Davis's work. Through a series of readings, this study investigates how Davis's translations and stories relate to each other, finding that they are inextricably interlinked. It explores how Davis uses translation - either as a compositional tool or a plot device - and other instances of rewriting in her stories, demonstrating that translation is central for understanding her prose. Understanding how Davis's work complicates divisions between translating and other forms of writing highlights the role of translation in literary production.Key FeaturesThe first monograph on this key contemporary writer that analyses texts from throughout her careerA series of analyses of Davis's major translations and how her work interacts with themA rethinking of the role of translation in literary production and the boundaries between translating and writing
Lydia Davis has long been regarded as a ‘writer's writer’. Her working form is the short story and often these are very short, some only one sentence long. In a reading public used to novels, it's easy for Davis’ work to slip between the cracks. The publication of her Collected Stories, in 2009, gave a much more substantial view of her career as a writer than had previously been available in one place. Davis won the 2013 Man Booker International prize, giving her much more international recognition.
Yet Davis had already received international recognition as a translator. She became a Chevalier de l'Ordre des Arts et Lettres in France in 1999. She has translated a substantial number of books from French, including, most famously, a new translation of Marcel Proust's Du côté de chez Swann (Proust 2002). She has also translated five of Maurice Blanchot's fictional texts, including Death Sentence (Blanchot 1978), and two volumes of the surrealist poet Michel Leiris’ autobiography, Scratches (Leiris 1997a) and Scraps (Leiris 1997b). Most recently, in 2010, she published a new translation of Flaubert's Madame Bovary. These are only the most high profile translations; between 1978 and 2002 she translated over twenty book-length works, including four novels by Pierre-Jean Jouve, two novels by Conrad Detrez, a travelogue by Michel Butor, a biography of Alexis de Tocqueville, as well as a book on masculine identity by Elizabeth Badinter, and several more novels and non-fiction works. Davis’ career as a translator began at the same time as her career as a writer: she published her first book-length translation, with Paul Auster, in 1975. The pair went on to translate four more books together, including a book of Sartre's interviews and a novel, Aboard the Aquitaine, by Georges Simenon.
Davis’ work, I argue in this book, challenges the separation between writing and translating. Through an exploration of the relationship between her translations and her own work, as well as an investigation into how Davis uses translation in her stories, The Many Voices of Lydia Davis questions the division between her roles as a writer and as a translator and the separation between the two modes of creativity.
Davis’ translation of Madame Bovary: Provincial Ways (2010) is her most recent translation from French and one that was written in her maturity. The perception of translation as a form of training for writing, which I discussed in the Introduction, seems least applicable here: at the point of writing her translation of Madame Bovary, Davis had already been awarded a MacArthur Fellowship in 2003 and had already published six collections of short stories, four of which were with major presses, and her novel. By the time the translation was published in 2010, Davis’ Collected Stories was also in print. It is safe to say that at this point she was an established writer.
Yet she chose to continue translating. The hierarchy of writing and translation, where the former is seen as more valuable, is always questioned by Davis’ work, but here it seems most problematic. As with her other, later translations, Davis was working on stylistically complex writing.Where Leiris and Proust may be less commonly read, even if Proust is well known, Flaubert's Madame Bovary is popular and regarded as ‘an important landmark in the history of the novel’ (Davis 2011b: 66). Indeed, in her introduction to the text, Davis argues that ‘Madame Bovary permanently changed the way novels were written thereafter’ (2011a: xi). Davis (2011b: 67) found eighteen different previous translations of it, suggesting that it had been popular since its first translation by Mary Neal Sherwood (published in 1881). The narrative of Madame Bovary is itself banal: a young woman marries a country doctor and dreams of a more exciting life. She reads magazines and novels by Eugene Sue, Balzac and Georges Sand to inform herself about Paris (Flaubert 2001: 111; Flaubert 2011a: 49–50). She conducts affairs first with Rodolphe, then with Léon. Neither affair really satisfies her craving for a more exciting life. Her inability to deal with financial matters leads to her owing 8,000 francs to Monsieur Lheureux and the bailiffs coming to sell off the Bovarys’ possessions. Emma commits suicide by taking arsenic. Her husband is left destitute and dies soon afterward, leaving their daughter Berthe to be looked after by a poor aunt who sends her to work in a cotton mill.
Davis’ most enduring relationship as a translator is with Maurice Blanchot. She began publishing her translation of Death Sentence in 1975 in the magazine Living Hand, which Davis and her then husband Paul Auster edited. Over the next eighteen years, Davis translated six books of Blanchot's: L'Arrêt de mort (1977, first published 1948) as Death Sentence (1978), Au moment voulu (1951) as When the Time Comes (1985), Celui qui m'accompagnait pas (1953) as The One Who Was Standing Apart from Me (1993), Le dernier homme (1957) as The Last Man (1987), La folie du jour (2002, first published 1973) as ‘The Madness of the Day’ (1977) and The Gaze of Orpheus and other literary essays (1981). The first four of these are novella-length texts, called ‘récits’ by Blanchot. The fifth, ‘The Madness of the Day’, is a short text that was published separately as a book in 1981, despite only being nine full pages in length in its 1977 English magazine publication and the same when it was reprinted in The Station Hill Blanchot Reader (Blanchot 1999: 191–9). Davis’ other translation, The Gaze of Orpheus and other literary essays (Blanchot 1981b), was the first English collection of Blanchot's critical essays. It contains work from Blanchot's collections Faux pas (1943), La Part du feu (1949), L'Espace littéraire (1955), Le Livre à venir (1959) and L'Entretien infini (1969). It appeared just before two other translations of Blanchot's essays (Blanchot 1982a and 1982b).
Davis has stated how important translating Blanchot was for her as a translator. While translating him she ‘learned to stay extremely close to the text … practising an extreme fidelity’ (Davis 2007b: 7). She published early versions of her translations in magazines (Blanchot 1975, 1976, 1977) which, with the exception of Michel Leiris’ work, is something she has not done with her other translations, although it mirrors her practice with her own short stories. These early publications increased her visibility as a translator and helped to establish her reputation.
As Davis’ responses to her translated texts have shown, there is a porous border between authorship and translation in her work, with connections appearing between her translations and her writing. Davis goes further in some of her stories: her ‘Stories from Flaubert’ and ‘Marie Curie, So Honorable Woman’ use translation as a form of composition. This chapter focuses on other instances in Davis’ stories where she has used a discernible source text as a basis for her own work. ‘The Walk’ (Davis 2007a: 72–82), for example, cites different translations from Proust's Du côté de chez Swann to demonstrate different characters’ perceptions of an event, while ‘Kafka Cooks Dinner’ (Davis 2007a: 9–18) is a pastiche of Kafka's style. ‘Southward Bound, Reading Worstward Ho’ (Davis 2007a: 68–71) combines citation and pastiche in a way that allows it to comment on Beckett's Worstward Ho (1999) while at the same time recounting its own narrative. The citational nature of all of these stories means that they recontextualise material from elsewhere, creating moments in the text which are doubly coded, pointing the reader to another text while also forming part of Davis’ story. This process is similar to what happens with translations, where the target text is both a new text and a representation of the source text.
This sort of double coding is often associated with postmodern art, which Linda Hutcheon (1988: 4) characterises by its rewriting and revising of past art forms. Certainly, in postmodern American fiction – the literary context for Davis’ work – there is much rewriting of other texts. Christian Moraru dedicates his book Rewriting (2001) to the rewritings in prose authors such as E. L. Doctorow, Robert Coover, Paul Auster, Kathy Acker and others. In poetry, too, there is no shortage of writers using elements of others’ work in their own work, as Marjorie Perloff has explored in her Unoriginal Genius (2010). But the use of others’ texts is not limited to postmodernism, or contemporary literature: Gérard Genette's Palimpsestes (1992) covers examples from the ancient Greeks onward. Davis is not alone or unique in her use of other writers’ material as the basis for her own.
Davis’ relationship to Proust's In Search of Lost Time is the most complex of her relationships with texts she has translated. Davis's move towards a more literal, source-oriented form of translation, which began with Blanchot and was developed in her translation of Leiris, continues with her translation of Proust. She has stated how her ‘aim in [this] translation was to stay as close as possible to Proust's original in every way, even to match his style as nearly as [she] could’ (Davis 2002a: xxxi). This approach allowed Davis to focus on Proust's word choice and syntax, which is mirrored by her own careful selection of words in her translation as well as in her own stories.
Davis has discussed Proust's influence on her writing of The End of the Story (Knight 1999: 529). Given that her translation of The Way by Swann's was published later in her career, the process of translating Proust is not a determining feature of that influence. On the other hand, Davis’ reading of Proust was influenced by C. K. Scott Moncrieff's earlier translation (Proust 1960). She describes Proust as ‘going deeply into the impression that a thing made on him as a child or as an adult, exploring the nuances of the effect of an experience on the narrator’ (Knight 1999: 529). This is a process that can also be seen in Davis’ The End of the Story, which explores the narrator's relationship with an unnamed man and its aftermath. The End of the Story contains several intertextual references to In Search of Lost Time which position it as a Proustian novel. As this chapter shows, similarities of form and technique also make Proust a precursor for Davis: The End of the Story begs to be read within a tradition that stems from Proust. But, I will argue, Davis subverts the teleological goal of Proust's novel in her own, writing a narrative that has no goal to reach other than its own telling.
The End of the Story could be considered to rewrite elements of Proust's novel. This is not the only rewriting of Proust that takes place in Davis’ work, however, as her translation of The Way by Swann's can also be considered a form of rewriting.