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Despite the availability of more than 20 antiseizure drugs (ASDs) for the treatment of epilepsy, up to 30% of patients continue to experience disabling seizures and are classified as having medically refractory epilepsy (MRE).1 Some patients with MRE are candidates for resective surgery or other palliative interventions, such as disconnection therapies (callosotomy or subpial transections).2 Unfortunately, the majority of refractory patients are not candidates for these surgical options due to having multifocal epileptogenic foci, foci localized to an eloquent brain area or because the focus cannot be adequately localized.3,4 For some of these patients, stimulation therapy (also known as neuromodulation) is an alternative palliative treatment option. This chapter will review the different neuromodulation modalities that are available as adjunctive treatment of MRE. The impact of neuromodulation on sudden unexplained death in epilepsy (SUDEP) will be explored in the final section.
Around 60 000 people in England live in mental health supported accommodation. There are three main types: residential care, supported housing and floating outreach. Supported housing and floating outreach aim to support service users in moving on to more independent accommodation within 2 years, but there has been little research investigating their effectiveness.
A 30-month prospective cohort study investigating outcomes for users of mental health supported accommodation.
We used random sampling, accounting for relevant geographical variation factors, to recruit 87 services (22 residential care, 35 supported housing and 30 floating outreach) and 619 service users (residential care 159, supported housing 251, floating outreach 209) across England. We contacted services every 3 months to investigate the proportion of service users who successfully moved on to more independent accommodation. Multilevel modelling was used to estimate how much of the outcome and cost variations were due to service type and quality, after accounting for service-user characteristics.
Overall 243/586 participants successfully moved on (residential care 15/146, supported housing 96/244, floating outreach 132/196). This was most likely for floating outreach service users (versus residential care: odds ratio 7.96, 95% CI 2.92–21.69, P < 0.001; versus supported housing: odds ratio 2.74, 95% CI 1.01–7.41, P < 0.001) and was associated with reduced costs of care and two aspects of service quality: promotion of human rights and recovery-based practice.
Most people do not move on from supported accommodation within the expected time frame. Greater focus on human rights and recovery-based practice may increase service effectiveness.
The widespread use of smartphones makes effective therapies such as cognitive–behavioural therapy (CBT) potentially accessible to large numbers of people.
This paper reports the usage data of the first trial of Catch It, a new CBT smartphone app.
Uptake and usage rates, fidelity of user responses to CBT principles, and impact on reported negative and positive moods were assessed.
A relatively modest proportion of people chose to download the app. Once used, the app tended to be used more than once, and 84% of the user-generated content was consistent with the basic concepts of CBT. There were statistically significant reductions in negative mood intensity and increases in positive mood intensity.
Smartphone apps have potential beneficial effects in mental health through the application of basic CBT principles. More research with randomised controlled trial designs should be conducted.
The spatial and temporal development of shear-induced overturning billows associated with breaking internal solitary waves is studied by means of a combined laboratory and numerical investigation. The waves are generated in the laboratory by a lock exchange mechanism and they are simulated numerically via a contour-advective semi-Lagrangian method. The properties of individual billows (maximum height attained, time of collapse, growth rate, speed, wavelength, Thorpe scale) are determined in each case, and the billow interaction processes are studied and classified. For broad flat waves, similar characteristics are seen to those in parallel shear flow, but, for waves not at the conjugate flow limit, billow characteristics are affected by the spatially varying wave-induced shear flow. Wave steepness and wave amplitude are shown to have a crucial influence on determining the type of interaction that occurs between billows and whether billow overturning can be arrested. Examples are given in which billows (i) evolve independently of one another, (ii) pair with one another, (iii) engulf/entrain one another and (iv) fail to completely overturn. It is shown that the vertical extent a billow can attain (and the associated Thorpe scale of the billow) is dependent on wave amplitude but that its value saturates once a given amplitude is reached. It is interesting to note that this amplitude is less than the conjugate flow limit amplitude. The number of billows that form on a wave is shown to be dependent on wavelength; shorter waves support fewer but larger billows than their long-wave counterparts for a given stratification.
This article illustrates and describes in detail a fine central European chasuble of the late c17 which, together with two dalmatics, ‘The Fetternear Vestments,’ were bequeathed to the Diocese of Aberdeen, in 1921 by the Leslie family, many of whom had been distinguished soldiers on the continent and especially in the Empire. After some contextual discussion of the alleged origins of the Leslie family and of their success in Imperial service, the article examines the traditional belief that the vestments, now at the Blairs Museum, Aberdeen, were made for Count James Leslie (c.1621-1694) partly out of Turkish textiles captured in 1683 at the Siege of Vienna. Detailed analysis of the embroidery on the chasuble, especially of the use of metal thread and ‘plate,’ demonstrates that the gold work is indeed of Turkish origin, the rest of the needle work central European, and thus makes the case that this extraordinary hybrid object is indeed a votive vestment made for the Catholic Leslies partly from captured Turkish work.
This article investigates sound change in the vowels of Māori, the indigenous language of New Zealand. It examines the relationship between sound changes in Māori and in New Zealand English, the more dominant language, with which Māori has been in close contact for nearly 200 years. We report on the analysis of three adult speaker groups whose birth dates span 100 years. All speakers were bilingual in Māori and New Zealand English. In total the speech of 31 men and 31 women was investigated. Analysis was done on the first and second formant values, extracted from the vowel targets. There has been considerable movement in the Māori vowel space. We find that the sound change in the Māori monophthongs can be directly attributed to the impact of New Zealand English, however the situation for the diphthongs is not so clear cut. There is some evidence that both New Zealand English monophthongs and diphthongs are impacting on the Māori diphthongs, but so too are the Māori monophthongs. We conclude that although New Zealand English has had a strong influence on Māori, there is very strong evidence that new generations of speakers of Māori are acquiring a phonemic system with its own internal parameters and consistencies.
This article explores the changing relationship between paupers and the parish authorities in Tongue, in the far north of Scotland, between the passing of the Scottish New Poor Law in 1845 and the end of the nineteenth century. It does so by focusing on Scottish pauper letters and petitions for relief. Such sources, though relatively abundant in the archives, have so far been ignored by welfare historians. The article begins with a discussion of the trials of Tongue's poor crofting community in the early years of the century, the impact of widespread land clearance, and the dislocation of long-established communities. Following on from this, through a close reading of pauper appeals alongside other official sources the authors demonstrate that, despite persistent hardship and inadequate resources, the relationship between paupers and the parish authorities changed markedly over the period. An attitude of supplication and entreaty, rooted in Highland traditions of deference and reflective of a rigid social hierarchy, gave way to a clear sense of entitlement and an expectation that paupers' appeals would—indeed, must—be heard toward the end of the century. This fundamental shift mirrored, and was profoundly influenced by, wider agitation among crofting communities for change.
Nutritious and enjoyable eating experiences are important for the health and wellbeing of older adults. Social gerontology has usefully engaged with the role of time in older adults’ eating lives, considering how routines and other temporal patterns shape experiences of food, meals and eating. Building on this foundation, the paper details one set of findings from qualitative doctoral research into older adults’ experiences of food, meals and eating. Informed by phenomenological ethnography, it engages with one of four dimensions of the human lifeworld – the temporal dimension. The research involved repeated in-depth interviews, walking interviews and observation with 21 participants aged 72–90 years, living in rural Tasmania, Australia. The temporal elements of older adults’ experiences are detailed in terms of the past, present and future. The findings show that older adults have vivid memories of eating in uncertain and austere times, and these experiences have informed their food values and behaviours into old age. In the present, older adults employ several strategies for living and eating well. Simultaneously, they are oriented towards their uncertain eating futures. These findings reveal the implicit meanings in older adults’ temporal experiences of food, meals and eating, highlighting the importance of understanding older adults’ lifeworlds, and their orientation towards the future, for developing effective responses to concerns about food and eating in this age group.
Medieval English Theatre is the premier journal in early theatre studies. Its name belies its wide range of interest: it publishes articles on theatre and pageantry from across the British Isles up to the opening of the London playhouses and the suppression of the civic mystery cycles, and also includes contributions on European and Latin drama, together with analyses of modern survivals or equivalents, and of research productions of medieval plays. This volume includes essays on spectatorship, audience reception and records of early drama, especially in Scotland, besides engaging with the current interest in the Towneley Plays and the history of its manuscript.Editors: Sarah Carpenter, Pamela M. King, Meg Twycross, Greg Walker.
Medieval English Theatre Meeting 2015 Change of publication details
The 2015 METh meeting was held at the University of Southampton, hosted by John McGavin. His carefully timetabled proceedings were interrupted by the unscheduled (by him) presentation of a Festschrift in his honour. He holds the unique composite volume, but the articles it contains will be divided between this volume of METh (Part One), and Volume 38 (Part Two).
The rest of the day lived up to its festive beginning. A range of papers on the topic of ‘Paradigms Lost’ highlighted those once entrenched scholarly positions about which we have changed our minds. Pamela M. King, in ‘Medieval Drama Criticism before METh’, introduced the late nineteenth-century work of Adolphus William Ward; Garrett Epp, on ‘Things we can no longer say about the Towneley Plays’, gave an impressive PowerPoint show of deletions of accepted ‘facts’; while Meg Twycross summarised new evidence on the provenance of the manuscript (see this volume). Other speakers introduced new material which extends or changes our approach to well-worn topics: Lindsey Cox showed us the visual evidence for the portrait miniature in Wit and Science, and how the different parts of the audience might have perceived it, and Jason Burg sketched the changing patterns of performance in Lincoln Cathedral between 1309 and 1642. Nadia van Pelt reminded us of the necessity of looking at original manuscript sources rather than their calendared summaries by discussing the enigmatic detail of a letter from Chapuys which reports Henry VIII's visit to a St John's Day pageant showing him ‘cutting off the heads of the clergy’; while Greg Walker rounded off the day with a masterly summation of recent critical approaches to spectatorship, and where they fell short.
Elisabeth Dutton gave us our own spectatorly experience. Before lunch, James McBain and Stephanie Allen of the EDOX (Early Drama at Oxford University) project spoke about ‘Rehabilitating Academic Drama’, and just after lunch this was put to the test by an enthusiastic reading of the play of Narcissus originally mounted by the undergraduates of St John's College, Oxford, as a Christmas entertainment in 1602.
Volumes 37 and 38 of Medieval English Theatre offer a collection of essays to honour John McGavin. Written by his friends and colleagues, students and admirers, these all testify to the deep affection as well as the academic esteem in which John himself and his work across the discipline of early theatre are held. Many reflect his own particular interests in the early drama of England and, especially, of Scotland: its records and narratives, its spectators, its intellectual and affective strategies, and its cultural work. There are papers on many aspects of Scottish theatrical culture, from ceremonial (Williamson) to Sir David Lyndsay (Hadley Williams, Happé, and Walker); from foolery (Carpenter) to Dunbar's dramatic voice (Jack). John's abiding interest in spectatorship and audience reception is approached from different angles, in morality drama (Steenbrugge), dialogue (Bose), in the York Play (King), academic drama (Dutton), and theory (van Pelt). His authoritative work in the creative interpretation of records and narratives, of both dramatic and para-dramatic performance, is reflected in essays on coronation ceremony (Hunt), libel (Egan), and monastic crucifixion games (Klausner). His steering role in the project on Early Modern London Theatres is commemorated in the online Bear Hunt (MacLean and Hagen). Three essays engage with one of the central current concerns of early theatre study, the Towneley manuscript and its plays (Epp, Johnston, and Twycross), while two more address uniquely revealing single plays: the Digby Mary Magdalen (Godfrey), and the Welsh Troelus a Chresyd (Niebrzydowski).
John's work has indeed come to epitomise ‘the best pairt of our play’. The number of essays contributed to the collection, by scholars young and old across the whole field of early drama studies, shows the range of his influence on the discipline itself and on generations of those working within it. This collection is offered as a tribute both to his creative scholarship and his collegiality. There is no space here for all the many friends and colleagues who would like to salute him on this occasion; but we hope that the recollections of three voices, offering memories and appreciation from John's student days to the present, may speak for us all.
Rehabilitation counsellors have long been interested in back injuries among at-risk occupational groups such as nurses. Back injuries have a high prevalence among nurses, with enormous financial costs being incurred by health agencies and governments. Consequently the prevention of back injuries is a high priority for all concerned. Following a discussion of prevalence studies and risk factors for back injuries, we selectively review research on the effectiveness of multi-component (education and exercises) preventive programs designed specifically for nurses. While there is some empirical support for preventive programs, research in the area is still in its infancy. Looking at the broader picture, we conclude that preventive efforts must ultimately address the design of the workplace and the availability of proper equipment. Importantly, nursing unions and governments are moving towards “no lifting” policies and re-organisation of work practices. For effective rehabilitation, though, of those who do suffer back injuries, the adoption of a Workplace Disability Management approach (rather the traditional OH&S and return to work services provided by health and rehabilitation professionals) is advocated.