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Late-life depression (LLD) is associated with poor social functioning. However, previous research uses bias-prone self-report scales to measure social functioning and a more objective measure is lacking. We tested a novel wearable device to measure speech that participants encounter as an indicator of social interaction.
Twenty nine participants with LLD and 29 age-matched controls wore a wrist-worn device continuously for seven days, which recorded their acoustic environment. Acoustic data were automatically analysed using deep learning models that had been developed and validated on an independent speech dataset. Total speech activity and the proportion of speech produced by the device wearer were both detected whilst maintaining participants' privacy. Participants underwent a neuropsychological test battery and clinical and self-report scales to measure severity of depression, general and social functioning.
Compared to controls, participants with LLD showed poorer self-reported social and general functioning. Total speech activity was much lower for participants with LLD than controls, with no overlap between groups. The proportion of speech produced by the participants was smaller for LLD than controls. In LLD, both speech measures correlated with attention and psychomotor speed performance but not with depression severity or self-reported social functioning.
Using this device, LLD was associated with lower levels of speech than controls and speech activity was related to psychomotor retardation. We have demonstrated that speech activity measured by wearable technology differentiated LLD from controls with high precision and, in this study, provided an objective measure of an aspect of real-world social functioning in LLD.
Significant inter-centre variability in the intensity of endomyocardial biopsy surveillance for rejection following paediatric cardiac transplantation has been reported. Our aim was to determine if low-intensity biopsy surveillance with two scheduled biopsies in the first year would produce outcomes similar to published registry outcomes.
A retrospective study of paediatric recipients transplanted between 2008 and 2014 using a low-intensity biopsy protocol consisting of two surveillance biopsies at 3 and 12–13 months in the first post-transplant year, then annually thereafter. Additional biopsies were performed based on echocardiographic and clinical surveillance. Excluded were recipients that were re-transplanted or multi-organ transplanted or were followed at another institution.
A total of 81 recipients in the first 13 months after transplant underwent an average of 2 (SD ± 1.3) biopsies, 24 ± 6.8 echocardiograms, and 17 ± 4.4 clinic visits per recipient. During the 13-month period, 19 recipients had 24 treated rejection episodes, with the first at an average of 2.8 months post-transplant. The 3-, 12-, 36-, and 60-month conditional on discharge graft survival were 100%, 98.8%, 98.8%, and 90.4%, respectively, comparable to reported figures in major paediatric registries. At a mean follow-up of 4.7 ± 2.1 years, four patients (4.9%) developed cardiac allograft vasculopathy, three (3.7%) developed a malignancy, and seven (8.6%) suffered graft loss.
Rejection surveillance with a low-intensity biopsy protocol demonstrated similar intermediate-term outcomes and safety measures as international registries up to 5 years post-transplant.
The marquess of Ormond's surrender of Dublin to the forces of the English parliament in the summer of 1647 has been seen as marking the demise of the Church of Ireland, with ministers given the choice of adopting the Presbyterian Directory for Public Worship or fleeing the country. This article examines the survival of the church thanks to the benign influence of the governor of Dublin, Colonel Michael Jones, and his brother, Dr Henry Jones, bishop of Clogher. Under Michael Jones's rule the Book of Common Prayer continued to be used, ministers were appointed to vacancies, and clerical networks continued to operate. It was only after the Cromwellian invasion in August 1649, and the replacement of Jones by the Cromwellian hard-liner, Colonel John Hewson, that the church was forced out of business – a process completed with its formal abolition by the autumn of 1650.
The clinical utility of the multidimensional Framework for Routine Outcome Measurement in Liaison Psychiatry (FROM-LP) has not previously been examined. We sought to establish whether referral accuracy and ability to achieve the reason(s) for referral to our liaison service improved after incorporating the Identify and Rate the Aim of the Contact (IRAC) scale of this tool into our referral process. We carried out a retrospective analysis of electronic case notes of all appropriate referrals to the team before and after this adaption.
Accuracy of referrals to our team improved from 73.8 to 93.7% following intervention. Referral requests that were fully achieved improved from 57.4 to 77.8%, and referral requests that were not achieved decreased from 26.2 to 6.4%.
The IRAC component of the FROM-LP measures what it was developed for, and thus has clinical utility supporting its widespread adoption across liaison services in the National Health Service.
Did the voters take their turn at the hustings and then go home, forgetting and forgotten, or did the member maintain close and constructive links with his constituency? In other words, were the wishes and interests of the people outside Parliament effectively represented?
This was the question posed by Derek Hirst as part of his important study of representation in early Stuart England. His answer, after a detailed investigation of the surviving evidence, was that the relationship between members of Parliament and their constituents was growing ever closer in the early seventeenth century. Indeed, at the beginning of the Long Parliament, ‘to many both in Parliament and country … the people were no longer merely to be governed, but they were to act in partnership with their representatives in the House’. Despite Hirst's optimistic prognosis, this situation was eminently reversible. The experience of the Civil Wars, purges of Parliament, the execution of the King, and the repeated forced dissolutions of Parliament all had the potential to erode that ‘partnership’. The Protectorate itself could be seen to mark another stage in that process of erosion. In chapters 3 and 4, we saw the way in which elections were managed, with varying degrees of success, the extent to which changes to the constituencies, the new franchise, and the qualifications demanded of voters influenced the make-up of the Protectorate Parliaments, and how exclusions moulded the Commons in 1654 and 1656, creating what some contemporaries viewed as ‘forced’ Parliaments.
To his highness the Lord Protector of the commonwealth of England, Scotland and Ireland.
The humble Remonstrance of the knights, citizens and burgesses now assembled in the Parliament of this commonwealth.
We, the knights, citizens and burgesses in this present Parliament assembled, taking into our most serious consideration the present estate of these three nations, joined and united under your highness's protection, cannot but in the first place with all thankfulness acknowledge the wonderful mercy of Almighty God in delivering us from that tyranny and bondage, both in our spiritual and civil concernments, which the late king and his party designed to bring us under, and pursued the effecting thereof by a long and bloody war, and also it hath pleased the same gracious God to preserve your person in many battles, to make you an instrument for preserving our peace, although environed with enemies abroad and filled with turbulent, restless and unquiet spirits in our own bowels. And we have great cause to hope that as the Lord hath used you so eminently in treading down our enemies and restoring us to peace and tranquillity, so also that he will further use you in the settling and securing our liberties, both as we are men and Christians, which are those innate and glorious ends which the good people of these nations have so freely, with the hazard of their lives and estates in a two years' war, so earnestly contended for.
It is ironic that historians have tended to neglect the constitutions that framed the Protectorate, and dominated its Parliaments. There were in fact six different constitutional documents considered between 1653 and 1657: the Instrument of Government that established the Protectorate in December 1653; the failed Parliamentary Constitution (or ‘government bill’) of 1654–5; the monarchical Remonstrance introduced on 23 February 1657; the Humble Petition and Advice which replaced it on 31 March, and was itself turned into a Protectoral constitution on 25 May (which passed into law on 26 June); and finally the explanatory Additional Petition and Advice presented to Cromwell at the end of June, as a companion to the Humble Petition. Of these, only the Instrument has been thoroughly examined by modern historians, and the most detailed studies of the Parliamentary Constitution and the Humble Petition remain those of S. R. Gardiner and C. H. Firth, published over a century ago, as more recent students have concentrated on politics rather than constitutional affairs. Even the most basic requirement for a study of these constitutions – the availability of definitive printed texts of the original proposals – has not been met in two of the six cases: those of the Remonstrance and the monarchical version of the Humble Petition. The resolution of this textual ambiguity is the first task of this chapter.
Richard Cromwell's relationship with Parliaments inevitably stands in marked contrast to his father's relationship with them. Lord Protector for less than nine months compared to nearly five years, Richard's only Parliament consisted of a single session lasting less than three months. Furthermore, although Richard had been a member of both the first and second Protectorate Parliaments, he lacked the extended parliamentary experience that helps to set his father's handling of his Parliaments within a much longer context. Nevertheless, Richard's relations with Parliament deserve to be examined in their own right as an integral part of the parliamentary and political history of the Protectorate, and not merely to be seen as a codicil to the story told in chapter 6. This chapter will consider Richard's early career and parliamentary experience, and explore the development of his political and religious attitudes as reflected principally in his surviving speeches and correspondence. We will then turn to examine his relationship with the third Protectorate Parliament in 1659, and the reasons why that Parliament ultimately collapsed.
RICHARD CROMWELL'S EARLY CAREER
Richard was one month short of his 32nd birthday when he was proclaimed Lord Protector. Born on 4 October 1626, he was the third son of Oliver Cromwell and Elizabeth Bourchier. He was educated at Felsted School, probably served briefly in the Parliamentarian armies during 1647, and was admitted a member of Lincoln's Inn on 27 May 1647.
Over fifty years have passed since Hugh Trevor-Roper wrote his controversial assessment of the politics of the Protectorate Parliaments. His primary concern was to explain how Oliver Cromwell failed to get what he wanted from the Parliaments that sat in 1654 and 1656; but he was also interested in the nature of parliamentary management. His conclusions on Cromwell are well known, and provocative:
The one English sovereign who had actually been a member of Parliament proved himself as a Parliamentarian the most incompetent of them all. He did so because he had not studied the necessary rules of the game. Hoping to imitate Queen Elizabeth, who by understanding these rules had been able to play upon her ‘faithful Commons’ as upon a well-tuned instrument, he failed even more dismally than the Stuarts.
According to Trevor-Roper, the corollary of this ‘vacuum of leadership’ at the centre was that the Protectorate Parliaments were beset by factionalism, with the ‘country’ party (led by ‘Presbyterian’ veterans from the 1640s) opposing the ‘courtiers’ in 1654–5, and the ‘kingship’ party in 1656–7 trying to foist a new monarchical constitution on Cromwell. The rejection of the crown gave power instead into the hands of the army, and this, together with the return of a republican caucus to Parliament in 1658 and 1659, brought chaos, and the ineffectual Richard Cromwell was forced to dissolve Parliament and resign as Protector.
This volume provides a detailed book-length study of the period of the Protectorate Parliaments from September 1654 to April 1659. The study is very broad in its scope, covering topics as diverse as the British and Irish dimensions of the Protectorate Parliaments, the political and social nature of factions, problems of management, the legal and judicial aspects of Parliament's functions, foreign policy and the nature of the parliamentary franchise and elections in this period. In its wide-ranging analysis of Parliaments and politics throughout the Protectorate the book also examines both Lord Protectors, all three Protectorate Parliaments and the reasons why Oliver and Richard Cromwell were never able to achieve a stable working relationship with any Parliament. Its chronological coverage extends to the demise of the Third Protectorate Parliament in April 1659. This comprehensive account will appeal to historians of early modern British political history.
Amidst the vast body of scholarly writing that has been published on seventeenth-century Britain in general, and on the revolutionary events of the 1640s and 1650s in particular, the period of the Cromwellian Protectorate from December 1653 to May 1659 remains relatively neglected. Several recent writers on Cromwell and the Interregnum have remarked on the lack of a detailed book-length study of the politics of the Protectorate, and specifically of the Protectorate Parliaments. Ivan Roots, for example, has observed that although ‘biographies of Cromwell abound … There is surprisingly little detailed work on the central government and politics of the Protectorate and less still specifically on the Protectorate Parliaments.’ Similarly, Barry Coward has commented that ‘there is no full published account of parliamentary politics during the Protectorate’, while Peter Gaunt has written that ‘the three Protectorate Parliaments … have attracted no … thorough investigation and remain sadly understudied. Moreover, most of the rather meagre attention has tended to focus on the second Protectorate Parliament, to the further neglect of the other two.’ A symposium on the Protectorate held in January 2004 at the History of Parliament Trust in London revealed both the limitations of the historiography to date and the remarkable potential for further research on this period. At present, there is no detailed monograph, focused on parliamentary history, that spans the period between the end of 1653 (when the studies by Blair Worden and Austin Woolrych end) and the autumn of 1658 (when that by Ronald Hutton begins).
The Protectorate saw various attempts, especially by Oliver Cromwell and his army allies, to use Parliament as a means to introduce radical religious reforms. These included efforts to improve the quality of the ministry and to extend liberty of conscience more widely. However, all three Protectorate Parliaments contained numerous members who sought a much more structured national church with penalties for those who refused to conform to it, and who therefore wished to frustrate the more libertarian aspects of the army's religious agenda. In the bitter debates that ensued about liberty of conscience, and particularly over the cases of John Biddle and James Nayler, the collision between Cromwell's religious vision and the attitudes and preferences of many within the Protectorate Parliaments became starkly apparent. This chapter will examine the causes and consequences of that collision, and the ways in which it destabilised the Protectorate Parliaments and forced changes within the Protectorate.
THE FIRST PROTECTORATE PARLIAMENT
The heart of the problem lay in Cromwell's desire to use a body designed as ‘the representative of the whole realm’ to advance what remained a minority agenda, ‘liberty of conscience’. In the end his wish to liberate the godly proved incompatible with the determination of many members to prevent the spread of heresies and blasphemies. The principal source of disagreement between Cromwell and a majority of members seems not to have been over whether religious reform was necessary, but over what sort of religious reform was desirable.
Oliver Cromwell's inability to achieve an effective working relationship with successive Parliaments during the 1650s remains one of the greatest ironies of the English Revolution. It was also a crucial reason why the English Republic failed to generate lasting political stability. This chapter will reconsider this problem and suggest that the principal difficulty lay in Cromwell's desire to use Parliament to reconcile the interests of the English nation as a whole with those of a godly minority (including himself) who embraced a radical religious agenda. He hoped that through Parliaments the nation and the godly people could become coterminous. His refusal to acknowledge the essential incompatibility of these two interests lay at the heart of his failure to find any Parliament that fulfilled his high hopes. This chapter will argue that the main reason for that failure ultimately lay in the incompatibility between the sort of reforms that Cromwell wanted Parliament to pursue – the vision of a godly commonwealth that he wished it to promote – and the attitudes and priorities of the majority of members of Parliament. Although, as Ivan Roots and Peter Gaunt have argued, and as is demonstrated elsewhere in this book, it is important not to overlook the legislative achievement of the Protectorate Parliaments, equally, their performance fell far short of what Cromwell desired. Always he searched for a Parliament that would promote his vision of a godly commonwealth, and always it eluded him.