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Beginning as early as A Descant for Gossips (1960), gay men and gay love come and go in Thea Astley’s prose oeuvre. The responses that these characters and this topic invite shift with point of view and under the impact of varied themes. Astley’s treatment refuses to be contained, either by traditional Catholic doctrines about sex or by Australia’s delay in decriminalising homosexual acts. Driven by love for her gay older brother Philip, whose death from cancer corresponded with her final allusions to gay love in The Multiple Effects of Rainshadow (1996), Astley’s only constant message on this, as on other topics, is humans’ responsibility to treat each other with kindness. This essay draws on Karen Lamb’s biography and on writings and reminiscences by Philip Astley’s family and fellow Jesuits to reveal his significance as his sister sought to resolve through her fiction the conflict between an inculcated Catholic idolisation of purity and her own hard-won understanding and acceptance of gay men.
The Royal College of Psychiatrists’ Parliamentary Scholar Scheme gives higher trainees in psychiatry the opportunity to spend 1 day a week in the House of Lords working alongside a peer with an interest in health. This article describes the work of the House of Lords and Parliament using examples from the experiences of 2017–2018 scholars and outlines ways doctors can get more involved in policy and politics.
Whole-grain cereal breakfast consumption has been associated with beneficial effects on glucose and insulin metabolism as well as satiety. Pearl millet is a popular ancient grain variety that can be grown in hot, dry regions. However, little is known about its health effects. The present study investigated the effect of a pearl millet porridge (PMP) compared with a well-known Scottish oats porridge (SOP) on glycaemic, gastrointestinal, hormonal and appetitive responses. In a randomised, two-way crossover trial, twenty-six healthy participants consumed two isoenergetic/isovolumetric PMP or SOP breakfast meals, served with a drink of water. Blood samples for glucose, insulin, glucagon-like peptide 1, glucose-dependent insulinotropic polypeptide (GIP), peptide YY, gastric volumes and appetite ratings were collected 2 h postprandially, followed by an ad libitum meal and food intake records for the remainder of the day. The incremental AUC (iAUC2h) for blood glucose was not significantly different between the porridges (P > 0·05). The iAUC2h for gastric volume was larger for PMP compared with SOP (P = 0·045). The iAUC2h for GIP concentration was significantly lower for PMP compared with SOP (P = 0·001). Other hormones and appetite responses were similar between meals. In conclusion, the present study reports, for the first time, data on glycaemic and physiological responses to a pearl millet breakfast, showing that this ancient grain could represent a sustainable alternative with health-promoting characteristics comparable with oats. GIP is an incretin hormone linked to TAG absorption in adipose tissue; therefore, the lower GIP response for PMP may be an added health benefit.
Background: Cognitive behavioural treatments are recommended for people with psychosis. Core beliefs regarding the self and others are a key part of the models underpinning cognitive behavioural therapy but detailed understanding of these putative beliefs in people with psychosis are limited. A greater understanding of these mechanisms is necessary to improve and refine treatments.
Aims: This study utilized a qualitative approach to explore core schematic beliefs in psychosis (strongly held positive and negative beliefs about the self and others) and their relation to hallucinations and delusions.
Method: Twenty individuals with psychosis participated in individual semi-structured interviews. Inductive thematic analysis was used to analyse the interviews.
Results: Four emergent themes were identified: (i) the solidity and permanency of core beliefs, (ii) the causes and development of core beliefs, (iii) a synergistic relationship between core beliefs and symptoms, and (iv) core beliefs associated with images and their influence on psychotic symptoms.
Conclusions: This study provides new insights into the range and character of core beliefs in psychosis and provides important data to guide ongoing and future development of treatment approaches for psychosis.
The long-accepted theory to explain why snow is slippery postulates self-lubrication: frictional heat from sliding melts and thereby lubricates the contacting snow grains. We recently published micro-scale interface observations that contradicted this explanation: contacting snow grains abraded and did not melt under a polyethylene slider, despite low friction values. Here we provide additional observational and theoretical evidence that abrasion can govern snow kinetic friction. We obtained coordinated infrared, visible-light and scanning-electron micrographs that confirm that the evolving shapes observed during our tribometer tests are contacting snow grains polished by abrasion, and that the wear particles can sinter together and fill the adjacent pore spaces. Furthermore, dry-contact abrasive wear reasonably predicts the evolution of snow-slider contact area, and sliding-heat-source theory confirms that contact temperatures would not reach 0°C during our tribometer tests. Importantly, published measurements of interface temperatures also indicate that melting did not occur during field tests on sleds and skis. Although prevailing theory anticipates a transition from dry to lubricated contact along a slider, we suggest that dry-contact abrasion and heat flow can prevent this transition from occurring for snow-friction scenarios of practical interest.
The mechanics of snow friction are central to competitive skiing, safe winter driving and efficient polar sleds. For nearly 80 years, prevailing theory has postulated that self-lubrication accounts for low kinetic friction on snow: dry-contact sliding warms snow grains to the melting point, and further sliding produces meltwater layers that lubricate the interface. We sought to verify that self-lubrication occurs at the grain scale and to quantify the evolution of real contact area to aid modeling. We used high-resolution (15 µm) infrared thermography to observe the warming of stationary snow under a rotating polyethylene slider. Surprisingly, we did not observe melting at contacting snow grains despite low friction values. In some cases, slider shear failed inter-granular bonds and produced widespread snow movement with no persistent contacts to melt (μ < 0.03). When the snow grains did not move and persistent contacts evolved, the slider abraded rather than melted the grains at low resistance (μ < 0.05). Optical microscopy revealed that the abraded particles deposited in air pockets between grains and thereby carried heat away from the interface, a process not included in current models. Overall, our results challenge whether self-lubrication is indeed the dominant mechanism underlying low snow kinetic friction.
Generational tensions are one of the many forms that land conflicts take in northern Uganda. The convention in Acholiland was that young men gained land-use rights through their fathers and young women gained them through their husbands. This pattern of generational governance has become complicated in the wake of the civil war and decades of internment in IDP camps. Lacking husbands, young women are using land of their patrilateral kin, while young men who grew up with their mothers may use that of their matrilateral relatives. This article, based on fieldwork in the Acholi subregion between 2014 and 2016, explores classic anthropological concerns about gerontocracy and patriliny in a contemporary postconflict situation. It describes the discreet land access strategies of young men and women and the ways in which they seek to complement dependence on relatives by renting or buying land. The image of the “war generation” as morally spoiled is countered by an examination of the consequences of war and internment for young people’s claims to use land.
Our objective was to examine and describe the common socio-demographic and clinical characteristics of first time older sex offenders.
Research papers published in MEDLINE, PsycINFO, and EMBASE were searched systematically. Following removal of duplicates and irrelevant papers, a total of 423 papers were reviewed to determine whether the selection criteria were met. A total of seven publications were included and evaluated by two researchers.
Of the seven publications, there were two retrospective research studies and five case reports. There was a higher proportion of neurocognitive disorder in this offender group and the victims were usually vulnerable individuals. Yet, cognitive assessments were rarely done or reported. Two subtypes of older sex offenders were identified: (i) offenders who had offended in the past but were not previously detected; (ii) first-time offenders with a high proportion of neurocognitive disorder.
There is a paucity of research in first time sex offending by older people. This review has highlighted a need for better designed studies to explore the characteristics of older sex offenders. Better collaboration between forensic and old-age psychiatric services is required for improved assessment and management of older sex offenders.
Research on the cities of the Classical Greek world has traditionally focused on mapping the organisation of urban space and studying major civic or religious buildings. More recently, newer techniques such as field survey and geophysical survey have facilitated exploration of the extent and character of larger areas within urban settlements, raising questions about economic processes. At the same time, detailed analysis of residential buildings has also supported a change of emphasis towards understanding some of the functional and social aspects of the built environment as well as purely formal ones. This article argues for the advantages of analysing Greek cities using a multidisciplinary, multi-scalar framework which encompasses all of these various approaches and adds to them other analytical techniques (particularly micro-archaeology). We suggest that this strategy can lead towards a more holistic view of a city, not only as a physical place, but also as a dynamic community, revealing its origins, development and patterns of social and economic activity. Our argument is made with reference to the research design, methodology and results of the first three seasons of fieldwork at the city of Olynthos, carried out by the Olynthos Project.
Susan Mlcek, Māori from Tauranga, New Zealand,
Kerry Taylor, Poche Centre for Indigenous Health and Well-Being in the Northern Territory,
Maree Meredith, Poche Centre for Indigenous Health and Well-Being in Alice Springs
One of the common questions asked by students and even staff involved in nursing education has been: ‘Why do we need a separate topic/chapter/course on Indigenous health?’ While this should be self-evident considering where the greatest health challenges of our time lie, it is not always clear. Indigenous peoples in countries such as Australia and Āotearoa New Zealand, although diverse in languages, cultures and histories, often share a common experience of profound relevance to health professionals today – an experience of being colonised that had detrimental and ongoing impact on health and well-being. However, in spite of these common experiences, there is also a resilience and capacity among Indigenous peoples that provides the community/primary health care nurse with an opportunity to affect real change towards better health outcomes.
This chapter introduces Indigenous approaches to health care that have relevance for the Australian and Āotearoa New Zealand contexts. Several of the principles for practice are readily transferrable to other culturally and linguistically diverse populations. The challenges are undeniably major, but the rewards are potentially transformative. Nursing training and education is most often located within mainstream, non-Indigenous settings. Health professionals who want to make a positive difference to the health outcomes of Indigenous clients should be equipped with knowledges and understandings which will facilitate effective engagement. Further, this chapter will examine the historical influences that have impacted on the health and well-being of Indigenous peoples in both Āotearoa New Zealand and Australia, and consider the need for adopting Indigenous approaches to health care practice and engagement such as cultural safety, cultural responsiveness and other cultural frameworks. Finally, it will examine the role of the community nurse in Indigenous primary health care.
A note on terminology before proceeding: ‘In the Australian context, the term “Indigenous” is used to refer to Aboriginal and Torres Strait Islander peoples and, with due respect, these terms are used interchangeably and acknowledge the diversity of languages and cultures that characterise Australian indigeneity’ (Rigby & Jeeawody, 2014, p. 283). In Āotearoa New Zealand, Māori are the first Indigenous peoples who can trace their ancestry and genealogy (whakapapa) right back to those who arrived in the early canoe fleet migrations of the mid-1300s (Ministry for Culture and Heritage, 2005) from the Tahitian and Hawai'iki regions.
Older people with dementia are at increased risk of physical decline and falls. Balance and mood are significant predictors of falls in this population. The aim of this study was to determine the effect of a tailored home-based exercise program in community-dwelling older people with dementia.
Forty-two participants with mild to moderate dementia were recruited from routine health services. All participants were offered a six-month home-based, carer-enhanced, progressive, and individually tailored exercise program. Physical activity, quality of life, physical, and psychological assessments were administered at the beginning and end of the trial.
Of 33 participants (78.6%) who completed the six-month reassessment ten (30%) reported falls and six (18%) multiple falls during the follow-up period. At reassessment, participants had better balance (sway on floor and foam), reduced concern about falls, increased planned physical activity, but worse knee extension strength and no change in depression scores. The average adherence to the prescribed exercise sessions was 45% and 22 participants (52%) were still exercising at trial completion. Those who adhered to ≥70% of prescribed sessions had significantly better balance at reassessment compared with those who adhered to <70% of sessions.
This trial of a tailored home-based exercise intervention presents preliminary evidence that this intervention can improve balance, concern about falls, and planned physical activity in community-dwelling older people with dementia. Future research should determine whether exercise interventions are effective in reducing falls and elucidate strategies for enhancing uptake and adherence in this population.
This article reports on a qualitative research study that explored the perspectives and lived experiences of children in a range of New Zealand rural environments. Thirty-six children, aged between 6 and 11 years, were interviewed about living in the country and also contributed artwork and photographs. They came from four specific rural locations, ranging from ‘rural with high urban influence’ to ‘highly rural/remote’. Children expressed positive views about aspects of rural living, such as opportunities for being outdoors and participating in social relationships, confirming a positive discourse of the rural idyll. Their accounts highlighted children's agency under complex and sometimes challenging conditions. Children also, however, experienced some aspects of rural life as dull, dangerous or difficult. The complex and nuanced constructions of rural childhood uncovered in this study point to the critical importance of consulting with children in order to understand their experiences and best meet the needs of rural children and families.
The extent to which indices of maternal physiological arousal (skin conductance augmentation) and regulation (vagal withdrawal) while parenting predict infant attachment disorganization and behavior problems directly or indirectly via maternal sensitivity was examined in a sample of 259 mothers and their infants. Two covariates, maternal self-reported emotional risk and Adult Attachment Interview attachment coherence were assessed prenatally. Mothers' physiological arousal and regulation were measured during parenting tasks when infants were 6 months old. Maternal sensitivity was observed during distress-eliciting tasks when infants were 6 and 14 months old, and an average sensitivity score was calculated. Attachment disorganization was observed during the Strange Situation when infants were 14 months old, and mothers reported on infants' behavior problems when infants were 27 months old. Over and above covariates, mothers' arousal and regulation while parenting interacted to predict infant attachment disorganization and behavior problems such that maternal arousal was associated with higher attachment disorganization and behavior problems when maternal regulation was low but not when maternal regulation was high. This effect was direct and not explained by maternal sensitivity. The results suggest that maternal physiological dysregulation while parenting places infants at risk for psychopathology.
The co-occurring development of internalizing and externalizing problems were examined in an inception cohort of 392 children diagnosed with autism spectrum disorder at age 3 who were assessed on four occasions. Results indicated that internalizing and externalizing problems were stable over time and highly comorbid. Joint trajectory analysis suggested that 13% of the sample followed a dual high-risk trajectory. High risk was not found to be associated with intellectual ability or autism spectrum disorder symptom severity but was linked to lower income and gender: more girls than boys were found in the high/stable internalizing problems trajectory. The results suggest that 1 in 4 preschoolers followed a trajectory of internalizing or externalizing problems (or a combination of the two) that could be characterized as clinically elevated.
Management of individuals with long QT syndrome, catecholaminergic polymorphic ventricular tachycardia, hypertrophic cardiomyopathy, and arrhythmogenic right ventricular cardiomyopathy may involve exercise restriction and/or β-blocker therapy.
This study assessed the practices of a group of paediatric electrophysiologists regarding the management of genotype-positive/phenotype-positive and genotype-positive/phenotype-negative individuals with these conditions.
An online survey was circulated to members of the Pediatric and Congenital Electrophysiology Society in May, 2014. The survey included questions addressing the respondents’ approach regarding exercise recommendations and prescription of β-blocker therapy.
A total of 45 cardiologists completed the survey. The majority of respondents restricted symptomatic patients from competitive sports; however, only approximately half restricted phenotype-negative mutation carriers from this level of activity. Recommendations were less consistent regarding other types of activities. A trend was identified regarding physician physical activity and exercise recommendations for phenotype-negative mutation carriers. Less-active physicians were more likely to restrict exercise. β-blocker therapy was discussed by the majority of respondents for symptomatic patients and a significant number of asymptomatic patients.
Exercise restriction for patients with long QT syndrome, catecholaminergic polymorphic ventricular tachycardia, hypertrophic cardiomyopathy, and arrhythmogenic right ventricular cardiomyopathy varies based on several factors including phenotype, type of exercise, guidelines referred to, and physicians’ own level of activity.
Variation in human cognitive ability is of consequence to a large number of health and social outcomes and is substantially heritable. Genetic linkage, genome-wide association, and copy number variant studies have investigated the contribution of genetic variation to individual differences in normal cognitive ability, but little research has considered the role of rare genetic variants. Exome sequencing studies have already met with success in discovering novel trait-gene associations for other complex traits. Here, we use exome sequencing to investigate the effects of rare variants on general cognitive ability. Unrelated Scottish individuals were selected for high scores on a general component of intelligence (g). The frequency of rare genetic variants (in n = 146) was compared with those from Scottish controls (total n = 486) who scored in the lower to middle range of the g distribution or on a proxy measure of g. Biological pathway analysis highlighted enrichment of the mitochondrial inner membrane component and apical part of cell gene ontology terms. Global burden analysis showed a greater total number of rare variants carried by high g cases versus controls, which is inconsistent with a mutation load hypothesis whereby mutations negatively affect g. The general finding of greater non-synonymous (vs. synonymous) variant effects is in line with evolutionary hypotheses for g. Given that this first sequencing study of high g was small, promising results were found, suggesting that the study of rare variants in larger samples would be worthwhile.
The aims of this study were twofold: (a) to explore whether specific components of shared decision making were present in consultations involving nurse prescribers (NPs), pharmacist prescribers (PPs) and general practitioners (GPs) and (b) to relate these to self-reported patient outcomes including satisfaction, adherence and patient perceptions of practitioner empathy.
There are a range of ways for defining and measuring the process of concordance, or shared decision making as it relates to decisions about medicines. As a result, demonstrating a convincing link between shared decision making and patient benefit is challenging. In the United Kingdom, nurses and pharmacists can now take on a prescribing role, engaging in shared decision making. Given the different professional backgrounds of GPs, NPs and PPs, this study sought to explore the process of shared decision making across these three prescriber groups.
Analysis of audio-recordings of consultations in primary care in South England between patients and GPs, NPs and PPs. Analysis of patient questionnaires completed post consultation.
A total of 532 consultations were audio-recorded with 20 GPs, 19 NPs and 12 PPs. Prescribing decisions occurred in 421 (79%). Patients were given treatment options in 21% (102/482) of decisions, the prescriber elicited the patient’s treatment preference in 18% (88/482) and the patient expressed a treatment preference in 24% (118/482) of decisions. PPs were more likely to ask for the patient’s preference about their treatment regimen (χ2=6.6, P=0.036, Cramer’s V=0.12) than either NPs or GPs. Of the 275 patient questionnaires, 192(70%) could be matched with a prescribing decision. NP patients had higher satisfaction levels than patients of GPs or PPs. More time describing treatment options was associated with increased satisfaction, adherence and greater perceived practitioner empathy. While defining, measuring and enabling the process of shared decision making remains challenging, it may have patient benefit.
To understand the genotypic spectrum of environmental contamination of Staphylococcus aureus in households and its persistence
Prospective longitudinal cohort investigation.
Index participants identified at 2 academic medical centers.
Adults and children with S. aureus skin infections and their household contacts in Los Angeles and Chicago.
Household fomites were surveyed for contamination at baseline and 3 months. All isolates underwent genetic typing.
We enrolled 346 households, 88% of which completed the 3-month follow-up visit. S. aureus environmental contamination was 49% at baseline and 51% at 3 months. Among households with a USA300 methicillin-resistant S. aureus (MRSA) body infection isolate, environmental contamination with an indistinguishable MRSA strain was 58% at baseline and 63% at 3 months. Baseline factors associated with environmental contamination by the index subject’s infection isolate were body colonization by any household member with the index subject’s infection isolate at baseline (odds ratio [OR], 10.93 [95% confidence interval (CI), 5.75–20.79]), higher housing density (OR, 1.47 [95% CI, 1.10–1.96]), and more frequent household fomite cleaning (OR, 1.62 [95% CI, 1.16–2.27]). Household environmental contamination with the index subject’s infection strain at 3 months was associated with USA300 MRSA and a synergistic interaction between baseline environmental contamination and body colonization by any household member with the index subject’s infection strain.
We found that infecting S. aureus isolates frequently persisted environmentally in households 3 months after skin infection. Presence of pathogenic S. aureus strain type in the environment in a household may represent a persistent reservoir that places household members at risk of future infection.
Infect Control Hosp Epidemiol 2014;35(11):1373–1382