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Increasing evidence suggests that circulating factors and immune dysfunction may contribute to the pathogenesis of schizophrenia. In particular, proinflammatory cytokines, complement and autoantibodies against CNS epitopes have recently been associated with psychosis. Related concepts in previous decades led to several clinical trials of dialysis and plasmapheresis as treatments for schizophrenia. These trials may have relevance for the current understanding of schizophrenia. We aimed to identify whether dialysis or plasmapheresis are beneficial interventions in schizophrenia. We conducted a systematic search in major electronic databases for high-quality studies (double-blinded randomised trials with sham controls) applying either haemodialysis or plasmapheresis as an intervention in patients with schizophrenia, published in English from the start of records until September 2018. We found nine studies meeting inclusion criteria, reporting on 105 patients in total who received either sham or active intervention. One out of eight studies reported a beneficial effect of haemodialysis on schizophrenia, one a detrimental effect and six no effect. The sole trial of plasmapheresis found it to be ineffective. Adverse events were reported in 23% of patients. Studies were at unclear or high risk of bias. It is unlikely that haemodialysis is a beneficial treatment in schizophrenia, although the studies were of small size and could not consider potential subgroups. Plasmapheresis was only addressed by one study and warrants further exploration as a treatment modality in schizophrenia.
This study examined the association and directionality of effect between mental wellbeing and depressive symptoms in Australian adolescents. Data were collected on two occasions 21 months apart. At Time 1, 1,762 10- to 14-year-old adolescents from a range of socio-economic status areas participated. At Time 2 (T2), 1,575 participated again. On both occasions, the Short Warwick-Edinburgh Mental Wellbeing Scale (SWEMWBS) and the Children's Depression Inventory 2 (CDI 2) were administered via online survey. Cross-lagged, longitudinal path analyses demonstrated a negative association between earlier symptoms of depression and later positive mental wellbeing, and that the reverse was also true, though weaker. The model accounted for 20% of the variance in males’ T2 CDI 2 depressive symptom scores (26% for females) and 21% of the variance in males’ T2 SWEMWBS mental wellbeing scores (23% for females). Depressive symptomatology and mental wellbeing were highly correlated, but symptoms of depression were more strongly associated with later mental wellbeing than vice versa. This has implications for educational psychologists, teachers, health professionals, and policy makers seeking to reduce depressive symptoms or promote mental wellbeing. Focusing solely on the promotion of mental wellbeing, without intervening to reduce symptoms of depression, may limit the potential outcomes that might be achieved.
While there is increasing recognition of the need to go beyond measures of mental ill health, there is a relative dearth of validated tools for assessing mental well-being among adolescents. The Warwick-Edinburgh Mental Well-being Scale (WEMWBS) is a promising tool for use in this context, and this study evaluated its use in an Australian context. The WEMWBS was completed by 829 Western Australian adolescents, aged from 13 to 16 years old, drawn from Grades 8, 9 and 10 in seven separate high schools. Using confirmatory factor analytic techniques, the utility of the full 14-item scale was not supported, but good fit for a previously validated seven-item short version (SWEMWBS) was supported. Strong measurement invariance was demonstrated across age, and weak measurement invariance was demonstrated across gender. The scale has good internal reliability. There were no differences in SWEMWBS scores across Grades 8 to 10. Overall, the SWEMWBS represents a useful tool for educational, developmental, and school psychologists investigating positive mental wellbeing in younger adolescents.
In recent years, the archaeology of Native American sites in colonial contexts has increased our understanding of how indigenous communities persisted in challenging times. Greater attention to practices helps to create a more enriched picture, especially when set in the context of food and consumption. This article considers shellfish remains excavated from three households on the Eastern Pequot reservation, located several kilometers Inland from the Connecticut coast in southern New England, to explore the role that shellfish gathering played in eighteenth-century subsistence and social practices in Native New England. Household variability in the specific species and quantity consumed, as well as disposal methods, provide insight into internal community decision making. Moreover, eighteenth-century reservation demographics strongly accentuate the role of women in the provision of these foodstuffs and in maintaining cultural connections to the coast and other off-reservation communities. Practices of gathering and consuming shellfish thus provide vectors of change and continuity in Native American communities of colonial New England, showing how these practices represent not only connections to a deeper past, but also ongoing and even resurging practices to engage with a colonial present.
The remains of the first Iron Age chariot burial in Britain outside Yorkshire were discovered during the winter of 2000–1, near the Bronze Age burial mound of Huly Hill, at Newbridge, Edinburgh. Excavated by Headland Archaeology (UK) Ltd with the assistance of the National Museums Scotland, the chariot proved unique beyond just its burial location. The Newbridge chariot was buried intact, a method consistent with the burial practices of Continental Europe rather than Yorkshire, where they were predominantly buried disassembled. Detailed post-excavation analysis revealed a history of repair and reuse, and construction techniques that indicate links with the chariot building traditions of both Yorkshire and Continental Europe. Fifth century bc radiocarbon dates for the burial place it firmly within La Tène A, consistent with its similarities to European examples and indicating that it pre-dates the known Yorkshire examples. This indicates the emergence of a British tradition of chariot construction by this time, familiar with Continental habits and technology but distinctively different in such areas as wheel construction and suspension fittings. Based on the findings, a reconstruction of the chariot was built for display in the National Museums Scotland, providing an opportunity further to understand and confirm the construction techniques observed or hypothesised during excavation.
Clinical and environmental isolates of pathogens are often unique and may be unculturable, yielding a very limited amount of DNA for genetic studies. Cryptosporidium in particular are difficult to propagate. Whole genome amplification (WGA) is a valuable technique for amplifying genomic material. In this study, we tested 5 WGA commercial kits using Cryptosporidium clinical isolates. DNA of 5 C. hominis and 5 C. parvum clinical isolates and C. parvum IOWA reference strain were used. The majority of the samples were amplified by all of the kits tested. The integrity and fidelity of the amplified genomic DNA were assessed by sequence analysis of several PCR products of varying length. We found evidence that one kit in particular may be more error prone while another seemed the more suitable kit for Cryptosporidium clinical samples, generating high molecular weight DNA from all the samples with high fidelity. Thus WGA was found to be a useful technique for producing amplified DNA suitable for downstream genotyping techniques and archiving of Cryptosporidium clinical isolates.
Expert clinical judgement combines technical proficiency with humanistic qualities.
To test the psychometric properties of questionnaires to assess the humanistic qualities of working with colleagues and relating to patients using multisource feedback.
Analysis of self-ratings by 347 consultant psychiatrists and ratings by 4422 colleagues and 6657 patients.
Mean effectiveness as rated by self, colleagues and patients, was 4.6, 5.0 and 5.2 respectively (where 1=very low and 6=excellent). The instruments are internally consistent (Cronbach's alpha > 0.95). Principal components analysis of the colleague questionnaire yielded seven factors that explain 70.2% of the variance and accord with the domain structure. Colleague and patient ratings correlate with one another (r=0.39, P<0.001) but not with the self-rating. Ratings from 13 colleagues and 25 patients are required to achieve a generalisability coefficient (Eρ2) of 0.75.
Reliable 360-degree assessment of humane judgement is feasible for psychiatrists who work in large multiprofessional teams and who have large case-loads.
The recent drive within the UK National Health Service to improve psychosocial care for people with mental illness is both understandable and welcome: evidence-based psychological and social interventions are extremely important in managing psychiatric illness. Nevertheless, the accompanying downgrading of medical aspects of care has resulted in services that often are better suited to offering non-specific psychosocial support, rather than thorough, broad-based diagnostic assessment leading to specific treatments to optimise well-being and functioning. In part, these changes have been politically driven, but they could not have occurred without the collusion, or at least the acquiescence, of psychiatrists. This creeping devaluation of medicine disadvantages patients and is very damaging to both the standing and the understanding of psychiatry in the minds of the public, fellow professionals and the medical students who will be responsible for the specialty's future. On the 200th birthday of psychiatry, it is fitting to reconsider the specialty's core values and renew efforts to use psychiatric skills for the maximum benefit of patients
In this groundbreaking collection of essays the history of philosophy appears in a fresh light, not as reason's progressive discovery of its universal conditions, but as a series of unreconciled disputes over the proper way to conduct oneself as a philosopher. By shifting focus from the philosopher as proxy for the universal subject of reason to the philosopher as a special persona arising from rival forms of self-cultivation, philosophy is approached in terms of the social office and intellectual deportment of the philosopher, as a personage with a definite moral physiognomy and institutional setting. In so doing, this collection of essays by leading figures in the fields of both philosophy and the history of ideas provides access to key early modern disputes over what it meant to be a philosopher, and to the institutional and larger political and religious contexts in which such disputes took place.