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To demonstrate the increasing evidence for an aetiological role of cerebral mitochondrial dysfunction in neuropsychiatric disorders.
To raise awareness of the importance of frontline staff partaking in post marketing surveillance of medications.
We report the cases of two patients who developed worsening BPSD, coinciding with starting the factor Xa inhibitor DOAC medications Apixaban and Rivaroxaban respectively. Both patients required detaining under the Mental Health Act (MHA). Their symptoms improved significantly, within two weeks, on switching to alternative anticoagulant therapies and they were both discharged from the acute psychiatric ward.
Frontline healthcare staff in acute settings and the community manage a heavy workload. It is all too easy to overlook potential neuropsychiatric drug side effects, especially if they are not clearly listed. They may be easily missed amongst older patients and wrongly attributed to dementia.
Rivaroxaban is structurally related to the antibiotic Linezolid which has been reported to cause mitochondrial toxicity. Pre marketing In vitro studies concluded the risk of mitochondrial toxicity associated with this anticoagulant to be low. However a more recent in vitro study, using rat kidney mitochondria, reported evidence of mitochondrial swelling and a collapse of the membrane potential following exposure to low doses of Rivaroxaban. The effect of Apixaban, which is structurally related to Rivaroxaban, has yet to be investigated on mitochondrial function.
Recent research supports not only an association between reduced cerebral mitochondrial function and neuropsychiatric symptoms and disorders, but also the aetiological role it may play.
There is a need for a far greater awareness and understanding of the potential cerebral mitochondrial toxicity of drugs commonly prescribed to our older populations.
Cerebral mitochondrial toxicity can have a significant impact on the health and well-being of patients.
Older patients are particularly prone to experiencing neuropsychiatric side effects that may not have been apparent during preclinical trials.
Development of a rating scale of drugs that are potentially less toxic to cerebral mitochondria could inform national prescribing guidelines and enable safer treatments to be offered to older people, reducing the likelihood of them experiencing apparent behavioural and psychological symptoms of dementia.
An intermediate-depth (1751 m) ice core was drilled at the South Pole between 2014 and 2016 using the newly designed US Intermediate Depth Drill. The South Pole ice core is the highest-resolution interior East Antarctic ice core record that extends into the glacial period. The methods used at the South Pole to handle and log the drilled ice, the procedures used to safely retrograde the ice back to the National Science Foundation Ice Core Facility (NSF-ICF), and the methods used to process and sample the ice at the NSF-ICF are described. The South Pole ice core exhibited minimal brittle ice, which was likely due to site characteristics and, to a lesser extent, to drill technology and core handling procedures.
The aim of this cross-sectional study was to examine the association between childhood obesity and modifiable population-level risk factors, after accounting for deprivation.
A review of the literature identified population-level risk factors including a healthy childcare setting, the local food environment, accessible open space, community safety and crime. Data for these risk factors were then identified and matched by each of the twenty-two local government areas in Wales to each child that had data on height and weight in the Wales Childhood Measurement Programme (CMP) (2012–2017). Multivariable logistic regression was used to identify associations with childhood obesity.
The current study was undertaken in Wales, UK, where approximately one in eight 4–5-year-olds are classified as obese.
All participants were children aged 4 or 5 years who attend school, measured as part of the CMP, between 2012 and 2017 (n 129 893, mean age 5·0 (sd 0·4) years).
After adjusting for deprivation, small but statistically significant associations were found between childhood obesity and percentage of land available as accessible open space OR 0·981 (95 % CI: 0·973, 0·989) P < 0·001) and density of fast food outlets OR 1·002 (95 % CI 1·001, 1·004, P = 0·001). No other population-level risk factors were associated with childhood obesity.
The current study indicates that, even after accounting for deprivation, risk factors such as the density of fast food outlets and access to green space should be considered when tackling childhood obesity as a public health issue.
The role of the Controller is critical to the effective monitoring of [privately managed prison] contracts. They need to have … the skills to understand and monitor the complex contractual relationship between private contractors and the Commissioner for Correctional Services. Their relationship with the senior managers in a contracted-out prison is of fundamental importance. (NAO, 2003: 55)
As has been referenced more than once in this volume, the UK operates the most marketised prison system in Europe. This chapter focuses on a specific relationship – that of the Controller and the Director – in order to examine how accountability is practised within this highly marketised system. There are currently 14 contracted-out prisons in England and Wales, with plans for more in the pipeline. In each, there is a Crown servant – a Controller – permanently based onsite. The Controller role was established in the late 1980s to mitigate concerns around diminishing state accountability for punishment in the face of prison privatisation. The 1991 Criminal Justice Act (CJA 1991) formalised the role, making Controllers responsible for reviewing the running of contracted-out prisons and investigating complaints against prison custody officers, reporting directly to the Secretary of State (SoS). Padfield (2018) describes Controllers as the ‘eyes and ears of the State’. Despite Controllers’ legal and political importance and their apparent centrality in holding private prison providers to account, there is little existing research about the role or its effectiveness (Padfield, 2018). Observers from the outside view the role as unclear, ideologically constrained and misunderstood (Le Vay, 2018). Further, the Controller role in England and Wales is unique. While there are similar ‘monitor’ roles for private prisons across other jurisdictions, for example in the US and Australia, they are not legally and/or organisationally conceived in the same way as Controllers.
Controllers in England and Wales are responsible for overseeing the operational delivery of the contract by providers. This is achieved by monitoring various prison performance metrics, such as levels of selfharm as well as provider compliance with contract delivery indicators and prison service instructions. Controllers can apply financial remedies against the contract in the event of noncompliance or poor performance, as specified in each contract. Together with their Senior Leaders, Controllers can invoke a rectification notice (performance improvement plan) that, if not achieved, may culminate in contract termination.
In a providential account of the changing relation between political economy and economics, the late nineteenth-century development of economics is identified with the rational choice model; and the revival of political economy in the late twentieth century comes with the export of this model to politics and the other social sciences. An alternative prudential account locates the revival of political economy with a significant qualification to the rational choice model. This qualification restores an eighteenth- and nineteenth-century view of rule-following to human agency. This essay sets out these accounts and draws the conclusion that the choice of one over the other matters, not least for the practice of contemporary politics.
The advent of genome wide association studies have resulted in the identification of a number of novel genetic loci for schizophrenia and related disorders. Understanding the functional impact of these variants on brain structure and function is crucial to understand their role in disease pathology. We presents data based on our genetic and neuropsychological assessment of almost 700 patients and healthy participants for a number of these variants and replication of our findings in independent samples of almost 1500 cases and controls. Specifically, we will use this data to suggest that the risk associated with some genetics variants (e.g. NOS1) is being mediated by an influence on variation in intelligence and other cognitive phenotypes, while other risk variants (e.g. ZNF804A) delineate illness subtypes in which cognitive deficits are a less prominent feature.
To identify discrete approaches to specialist healthcare support for older care home residents in the UK and to estimate their prevalence.
Internationally, a range of new initiatives are emerging to meet the multiple and complex healthcare needs of care home residents. However, little is known about their relative effectiveness and, given their heterogeneity, a classification scheme is required to enable research staff to explore this.
A UK survey collected information on the funding, age, coverage, aims, staffing and activities of 64 specialist care home support services. Latent class analysis (LCA) was used to allocate the sample into subgroups with similar characteristics.
Three classes were identified. Class 1 (55% of sample) contained services with a high probability of providing scheduled input (regular preplanned visits) and support for all residents and a moderate probability of undertaking medication management, but a low probability of training care home staff (‘predominantly direct care’). Class 2 (23% of sample) had a moderate/high probability of providing scheduled input, support for all residents, medication management and training (‘direct and indirect care’). Class 3 (22% of sample) had a low probability of providing scheduled input, support for all residents and medication management, but a high probability of providing training for care home staff (‘predominantly indirect care’). Consultants were more likely to be members of services in Class 1 than Class 2, and Class 2 than Class 3.
LCA offers a promising approach to the creation of a taxonomy of specialist care home support services. The skills and knowledge required by healthcare staff vary between classes, raising important issues for service design. The proposed classification can be used to explore the extent to which different organisational forms are associated with better resident, process and service outcomes.
Research suggests that a significant minority of hospital in-patients could be more appropriately supported in the community if enhanced services were available. However, little is known about these individuals or the services they require.
To identify which individuals require what services, at what cost.
A ‘balance of care’ (BoC) study was undertaken in northern England. Drawing on routine electronic data about 315 admissions categorised into patient groups, frontline practitioners identified patients whose needs could be met in alternative settings and specified the services they required, using a modified nominal group approach. Costing employed a public-sector approach.
Community care was deemed appropriate for approximately a quarter of admissions including people with mild-moderate depression, an eating disorder or personality disorder, and some people with schizophrenia. Proposed community alternatives drew heavily on carer support services, community mental health teams and consultants, and there was widespread consensus on the need to increase out-of-hours community services. The costs of the proposed community care were relatively modest compared with hospital admission. On average social care costs increased by approximately £60 per week, but total costs fell by £1626 per week.
The findings raise strategic issues for both national policymakers and local service planners. Patients who could be managed at home can be characterised by diagnosis. Although potential financial savings were identified, the reported cost differences do not directly equate to cost savings. It is not clear whether in-patient beds could be reduced. However, existing beds could be more efficiently used.
There is a growing concern about the mental health of children and young people (CYP) in the UK, with increasing demand for counselling services, admissions for self-harm and referrals to mental health services. We investigated whether there have been similar recent trends in selected mental health outcomes among CYP in national health surveys from England, Scotland and Wales.
Data were analysed from 140 830 participants (4–24 years, stratified into 4–12, 13–15, 16–24 years) in 36 national surveys in England, Scotland and Wales, 1995–2014. Regression models were used to examine time trends in seven parent/self-reported variables: general health, any long-standing health condition, long-standing mental health condition; Warwick–Edinburgh Mental Wellbeing Score (WEMWBS), above-threshold Strengths and Difficulties Questionnaire Total (SDQT) score, SDQ Emotion (SDQE) score, General Health Questionnaire (GHQ) score.
Across all participants aged 4–24, long-standing mental health conditions increased in England (0.8–4.8% over 19 years), Scotland (2.3–6.0%, 11 years) and Wales (2.6–4.1%, 7 years) (all p < 0.001). Among young children (4–12 years), the proportion reporting high SDQT and SDQE scores decreased significantly among both boys and girls in England [SDQE: odds ratio (OR) 0.97 (0.96–0.98), p < 0.001] and girls in Scotland [SDQE: OR 0.96 (0.93–0.99), p = 0.005]. The proportion with high SDQE scores (13–15 years) decreased in England [OR 0.98 (0.96–0.99), p = 0.006] but increased in Wales [OR 1.07 (1.03–1.10), p < 0.001]. The proportion with high GHQ scores decreased among English women (16–24 years) [OR 0.98 (0.98–0.99), p = 0.002].
Despite a striking increase in the reported prevalence of long-standing mental health conditions among UK CYP, there was relatively little change in questionnaire scores reflecting psychological distress and emotional well-being.
Twenty years ago, when we edited the first book devoted to creative works by writers, film-makers, musicians, cartoonists, and other artists born of immigrant parents originating in former French colonies, this was in many ways an unusual development. While France has long been a country of immigration, and many foreign-born artists have contributed to the nation's cultural creativity, until recently immigrant minorities have seldom been regarded as distinctive components within the cultural fabric of France. Since the 1980s, when young artists from post-colonial immigrant backgrounds first began to attract attention, they have been assumed by many among the majority-ethnic population in France to be imbricated in alien cultural traditions that make it impossible for them to be truly or fully French. Yet the vast majority of these new cultural practitioners feel and are French. In our 1997 volume, it was clear that their frequent marginalization arose far less from irreconcilable cultural differences than from a politicized system of ethnic differentiation inherited from the colonial period and reconstructed in post-colonial France. Today, it is equally clear from this new volume edited by Kathryn Kleppinger and Laura Reeck that, despite the passage of time, more than half a century after the liquidation of the vast majority of the French empire, the ethnic hierarchy that underpinned the colonial system overseas lives on in many ways within the Hexagon in neocolonial perceptions of the cultural practices of ‘Arabs’, ‘blacks’, and ‘Muslims’ as inherently extraneous and inferior to French norms even when the artists concerned are natives and citizens of France. We place the terms ‘Arabs’, ‘blacks’, and ‘Muslims’ in inverted commas to mark the fact that, as widely used in France, these terms and the notions they designate are social constructions that are both empirically questionable and often negatively connoted, stigmatizing minority-ethnic groups whose self-perceptions are frequently at variance with the attributes projected onto them. Tensions of this nature have been fundamental to the body of creative works produced by post-colonial minorities.
One interpretation of the evidence on how people actually behave is that they sometimes/often do not have well-defined preferences. Although this makes public policy based on preference satisfaction problematic, it does not count against policy intervention per se. This paper argues instead that it shifts the object of intervention to the rules that constrain and enable action (away from the outcomes arising from those actions). This is the constitutional approach to public policy. Drawing on the constitutional tradition in political theory that values individuals for their individuality, the paper develops an argument for a basic income and a constitutionally constrained tax system. The key feature of this system is its simplicity. This should appeal on behavioural grounds to anyone who is concerned with using the tax and benefit system in public policy and not just those who are persuaded by the argument here for the constitutional approach to public policy.
Cognitive remediation (CR) training has emerged as a promising approach to improving cognitive deficits in schizophrenia and related psychosis. The limited availability of psychological services for psychosis is a major barrier to accessing this intervention however. This study investigated the effectiveness of a low support, remotely accessible, computerised working memory (WM) training programme in patients with psychosis.
Ninety patients were enrolled into a single blind randomised controlled trial of CR. Effectiveness of the intervention was assessed in terms of neuropsychological performance, social and occupational function, and functional MRI 2 weeks post-intervention, with neuropsychological and social function again assessed 3–6 months post-treatment.
Patients who completed the intervention showed significant gains in both neuropsychological function (measured using both untrained WM and episodic task performance, and a measure of performance IQ), and social function at both 2-week follow-up and 3–6-month follow-up timepoints. Furthermore, patients who completed MRI scanning showed improved resting state functional connectivity relative to patients in the placebo condition.
CR training has already been shown to improve cognitive and social function in patient with psychosis. This study demonstrates that, at least for some chronic but stable outpatients, a low support treatment was associated with gains that were comparable with those reported for CR delivered entirely on a 1:1 basis. We conclude that CR has potential to be delivered even in services in which psychological supports for patients with psychosis are limited.
The Psychology of Musical Development provides an up-to-date and comprehensive account of the latest theory, empirical research and applications in the study of musical development, an important and emerging field of music psychology. After considering how people now engage with music in the digital world, and reviewing current advances in developmental and music psychology, Hargreaves and Lamont compare ten major theoretical approaches in this field - including cognitive stage models and neuroscientific, ecological and social cognitive approaches - and assess how successfully each of these deals with five critical theoretical issues. Individual chapters deal next with cognition, perception and learning; social development; environmental influences on ability, achievement and motivation; identity, personality and lifestyle; affect and emotion; and well-being and health. With an emphasis on practical applications throughout, this book will be essential reading for students and scholars of music psychology, developmental psychology, music education and music therapy.