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This book offers an extensive analysis of Woolf's engagement with science. It demonstrates that science is integral to the construction of identity in Woolf's novels of the 1930s and 1940s, and identifies a little-explored source for Woolf's scientific knowledge: BBC scientific radio broadcasts. By analyzing this unstudied primary material, it traces the application of scientific concepts to questions of identity and highlights a single concept that is shared across multiple disciplines in the modernist period: the idea that modern science undermined individualized conceptions of the self. It broadens our understanding of the relationship between modernism and radio, modernism and science, and demonstrates the importance of science to Woolf's later novels.
Despite policy pressure and concerns regarding the use of antipsychotics and benzodiazepines, many care home residents with dementia are prescribed psychotropic medication, often off licence. This is the first large study to report psychotropic prescribing and ‘as required’ administration patterns in English care homes.
To explore the prevalence and associates of psychotropic prescription in care home residents with dementia and compare the results with national guidance.
We collected data in a longitudinal cohort study of residents with diagnosed or probable dementia in 86 care homes in England in 2014–2016. We reported the prevalence of psychotropic (antipsychotics, anxiolytics/hypnotics, antidepressants) prescriptions and drug receipt. We explored the associations between resident factors (sociodemographic, agitation [Cohen–Mansfield Agitation Inventory], dementia severity [Clinical Dementia Rating]) and care home factors (type, ownership, size, dementia registration/specialism, quality rating) in prescription and ‘as required’ administration, using multilevel regression models.
We analysed data from 1425 residents. At baseline, 822 residents (57.7%, 95% CI: 55.1–60.2) were prescribed a psychotropic drug, 310 residents (21.8% 95% CI: 19.7–24.0) were prescribed an anxiolytic/hypnotic, 232 (94.3%, 95% CI: 90.6–96.6) were prescribed one antipsychotic and 14 (5.7%, 95% CI: 3.4–9.4) were prescribed two antipsychotics. The median prescription duration during the study was 1 year. Residents with clinically significant agitation were prescribed more antipsychotics (odds ratio [OR] = 2.00, 95% CI: 1.64–2.45) and anxiolytics/hypnotics (OR = 2.81, 95% CI: 2.31–3.40).
Antipsychotics and anxiolytics/hypnotics are more commonly prescribed for people with dementia in care homes than in the community, and prescribing may not reflect guidelines. Policies which advocate reduced use of psychotropics should better support psychosocial interventions.
To examine how socio-demographic characteristics and diet quality vary with consumption of ultra-processed foods (UPFs) in a cross-sectional nationally representative survey of Australian adults.
Using a 24-hour recall, this cross-sectional analysis of dietary and socio-demographic data classified food items using the NOVA system, estimated the percentage of total energy contributed by UPFs and assessed diet quality using the Dietary Guideline Index (DGI – 2013 total and components). Linear regression models examined associations between socio-demographic characteristics and diet quality with percentage of energy from UPFs.
Australian Health Survey 2011-13
Australian Adults aged ≥ 19 years (n=8,209)
Consumption of UPFs was higher among younger adults (19-30 years), adults born in Australia, those experiencing greatest area level disadvantage, lower levels of education, and the second lowest household income quintile. No significant association was found for sex or rurality. A higher percentage of energy from UPFs was inversely associated with diet quality and with lower DGI scores related to the variety of nutritious foods, fruits, vegetables, total cereals, meat and poultry, fish, eggs, nuts and seeds, legumes/beans, water and limits on discretionary foods, saturated fat and added sugar.
This research adds to the evidence on dietary inequalities across Australia and how UPFs are detrimental to diet quality. The findings can be used to inform interventions to reduce UPF consumption and improve diet quality.
Contemporary debates on civil disobedience often turn on the question of what’s living and what’s dead in nonviolence. When protestors smash security cameras to hide their identities, hurl tear gas canisters back at police lines, or block highways to urge action from elected officials, they refuse the demand that disobedience be strictly nonviolent. The diversity of tactics embraced by recent protest movements around the globe raises questions about the continuing adequacy of the very idea of nonviolent civil disobedience for conceptualizing dissent. Some scholars have responded with calls for a more minimalist definition of civil disobedience that better encompasses these confrontational tactics.1 Others, such as Candice Delmas in her contribution to this volume, argue for abandoning the concept altogether in favor of theorizing this wider terrain as “uncivil” disobedience.
Faraday complexity describes whether a spectropolarimetric observation has simple or complex magnetic structure. Quickly determining the Faraday complexity of a spectropolarimetric observation is important for processing large, polarised radio surveys. Finding simple sources lets us build rotation measure grids, and finding complex sources lets us follow these sources up with slower analysis techniques or further observations. We introduce five features that can be used to train simple, interpretable machine learning classifiers for estimating Faraday complexity. We train logistic regression and extreme gradient boosted tree classifiers on simulated polarised spectra using our features, analyse their behaviour, and demonstrate our features are effective for both simulated and real data. This is the first application of machine learning methods to real spectropolarimetry data. With 95% accuracy on simulated ASKAP data and 90% accuracy on simulated ATCA data, our method performs comparably to state-of-the-art convolutional neural networks while being simpler and easier to interpret. Logistic regression trained with our features behaves sensibly on real data and its outputs are useful for sorting polarised sources by apparent Faraday complexity.
The relation between peer victimization and depressive symptoms is complex, requiring the use of methodologically rigorous designs to examine these relations and potential mediating factors. The current study used a random intercepts cross-lagged panel model (RI-CLPM) to investigate both between-person and within-person associations in peer victimization, depressive symptoms, and family cohesion across five waves in a sample of adolescents (N = 801, ages 13–15 years at recruitment) in the Northeast. We also investigated the moderating effects of sex and victimization status (i.e., bullying victimization vs. peer victimization). Overall, findings revealed a reciprocal relation between peer victimization and depressive symptoms for females, but no relation for males. A reciprocal relation between peer victimization and family cohesion was found for males. No significant differences were found by victimization status. Future research on peer victimization and associated outcomes and the role of family should account for both between-person and within-person variance.
Although there is growing evidence suggesting that eating patterns are important determinants of health status, comprehensive information on patterning of eating behaviours is almost lacking. The aim of this cross-sectional study was to describe eating patterns in Japan.
Information on actual eating behaviours was collected using 2-d dietary record in each season over a year (total 8 d). Eating occasions were defined as any discrete intake occasion (with a discrete start clock time and name) except for eating occasions consisting of water only, which were excluded.
A nationwide sample of 4032 Japanese aged 1–79 years.
The mean value of eating frequency of meals (i.e. breakfast, lunch and dinner), snacks and total eating occasions was 2·94, 1·74 and 4·68 times/d, respectively. The mean clock time for the start of breakfast, lunch and dinner was 07.24, 12.29 and 19.15 h, respectively. The mean time spent consuming breakfast, lunch, dinner and snacks was 19, 25, 34 and 27 min/d, respectively. On average, variability (i.e. average of absolute difference from mean) of meal frequency was small compared with that of snack frequency and total eating frequency. Both mean variability of clock time for the start of eating (<1 h) and mean variability of time spent on meals (<10 min/d) were also small. Conversely, mean variability of time spent on snacks was large (>18 min/d).
The present findings serve as both a reference and an indication for future research on patterning of eating behaviours.
This chapter examines connections between climatic determinist accounts of civilization and the tendency toward climate reductionism in recent writings on climate change and future societal collapse. It examines the writings of a sequence of key historical figures, notably, Hippocrates, Ibn Khaldūn, Montesquieu, and Buckle. Thereafter the work of a range of late nineteenth and early twentieth-century American writers including the chemist-historian John William Draper, geographers Ellsworth Huntington and Ellen Semple, and medical practitioners William Petersen and Clarence Mills are reviewed. Scrutiny of their pronouncements reveals the intimate connections such figures perceived between climate and health, wealth, war, eugenics, temperament, and civilization more generally. The essay foregrounds continuities between these proposals and the writings of some contemporary commentators on climate and economics, and on the implications of climate change for the future of human society.
The human body is a central entity and analytic within African life and Africanist scholarship. The source of perception and the seat of animation, of life, it grounds experience of the world while also providing a rich set of symbols from which humans draw in political, social, and religious life to create and communicate meaning. Livingston reviews approaches to the body as a key concept in Africanist scholarship, tracing regimes of bodily representation ranging from the deployment of bodily symbolism in ancient smelting furnaces to the hypervisibility of the black female body in the European colonial imagination. She discusses a welter of bodily experience, from the pain of childbirth and the vulnerabilities of illness and accident to the sensorium or the kinesthetic power of movement and dance. In the process, Livingston considers developments within the field of African Studies via the body.
This article explores the religious response of one neglected writer to the evolutionary philosophy of Herbert Spencer. William Todd Martin was a minister of the Presbyterian Church in Ireland and in 1887 published The Evolution Hypothesis: A Criticism of the New Cosmic Philosophy. The work demonstrates the essentially contested nature of “evolution” and “creation” by showing how a self-confessed creationist could affirm an evolutionary understanding of the natural world and species transformation. Martin's approach reflected a transatlantic Presbyterian worldview that saw the harmony of science and religion on the basis of Calvinism, Baconianism and Scottish Common Sense philosophy. Martin's critique is also relevant to issues that continue to animate philosophers of science and religion, including the connections between mind and matter, morality and consciousness in a Darwinian framework, and the relationship between subjective conscious experience and evolutionary physicalism. Martin was able to anticipate these debates because his critique was essentially philosophical and theological rather than biological and biblicist.
The coronavirus disease 2019 (COVID-19) pandemic led to measures that reduced social contact and support. We explored whether UK residents with more frequent or supportive social contact had fewer depressive symptoms during March−August 2020, and potential factors moderating the relationship.
A convenience sample of UK dwelling participants aged ⩾18 in the internet-based longitudinal COVID-19 Social Study completed up to 22 weekly questionnaires about face-to-face and phone/video social contact frequency, perceived social support, and depressive symptoms using the PHQ-9. Mixed linear models examined associations between social contact and support, and depressive symptoms. We examined for interaction by empathic concern, perspective taking and pre-COVID social contact frequency.
In 71 117 people with mean age 49 years (standard deviation 15), those with high perceived social support scored 1.836 (1.801–1.871) points lower on PHQ-9 than those with low support. Daily face-to-face or phone/video contact was associated with lower depressive symptoms (0.258 (95% confidence interval 0.225–0.290) and 0.117 (0.080–0.154), respectively) compared to no contact. The negative association between social relationships and depressive symptoms was stronger for those with high empathic concern, perspective taking and usual sociability.
We found during lockdown that those with higher quality or more face-to-face or phone/video contact had fewer depressive symptoms. Contact quality was more strongly associated than quantity. People who were usually more sociable or had higher empathy had more depressive symptoms during enforced reduced contact. The results have implications for COVID-19 and potential future pandemic management, and for understanding the relationship between social factors and mental health.
The National Institute for Health and Care Excellence (NICE) worked with patients and staff from six patient organizations to review existing health technology assessment (HTA) methods and coproduce proposals to improve the following: patient involvement, how patient evidence is identified and considered by committees, and the support offered to patient stakeholders. This engagement identified important factors that HTA bodies need to understand to enable meaningful patient and public involvement (PPI), such as having clearly documented processes, appropriate evidence submission processes, transparent decisions, and suitable support. This work demonstrated the benefits of HTA bodies working collaboratively with patient stakeholders to improve PPI. By doing so, HTA bodies can increase their knowledge and understanding of the barriers faced by patient stakeholders to develop appropriate solutions to remove them. The coproduction approach improved stakeholder engagement methods, provided a better analysis of data, supported the development of meaningful conclusions, and improved stakeholder relationships.
Accounts of patient experiences are increasingly used in health technology assessment (HTA) processes. However, we know little about their impact on the decision-making process. This study aims to assess the level and the type of impact of patient input to highly specialised technologies (HSTs) and interventional procedures (IPs) guidance at the National Institute for Health and Care Excellence (NICE).
A questionnaire was developed to capture quantitative and qualitative data on the amount and type of impact of patient input into NICE HTAs. It was completed by committee members of the guidance-producing programs after a discussion of the considered topics. The data were analyzed by topic and overall, for each program, and compared across programs.
Patient input was assessed on ten pieces of HST guidance published between January 2015 and November 2019, and on twenty-six pieces of IP guidance scoped between February 2016 and October 2018. A total of 96 responses were collected for HST and 440 for IP. The level of impact of patient input was higher for HST than for IP. For HST, no respondents stated that it had no impact, whereas in IP, 35 percent of respondents did. The most common types of impact found for HST and IP were that it helped interpret the other evidence and that it provided new evidence.
The impact of patient input is not necessarily explicit in changing recommendations, but it provides context, reassurance, and new information to the committee for the decision-making process in HTAs.
To develop an international template to support patient submissions in Health Technology Assessments (HTAs). This was to be based on the experience and feedback from the implementation and use of the Scottish Medicines Consortium's (SMC) Summary Information for Patient Groups (SIP).
To gather feedback on the SMC experience, web-based surveys were conducted with pharmaceutical companies and patient groups familiar with the SMC SIP. Semistructured interviews with representatives from HTA bodies were undertaken, along with patient group discussions with those less familiar with the SIP, to explore issues around the approach. These qualitative data informed the development of an international SIP template.
Survey data indicated that 82 percent (18 of 22 respondents) of pharmaceutical company representatives felt that the SIP was worthwhile; 88 percent (15/17) of patient group respondents found the SIP helpful. Both groups highlighted the need for additional support and guidance around plain language summaries. Further suggestions included provision of a glossary of terms and cost-effectiveness information. Patient group interviews supported the survey findings and led to the development of a new template. HTA bodies raised potential challenges around buy-in, timing, and bias connected to the SIP approach.
The international SIP template is another approach to support deliberative processes in HTA. Although challenges remain around writing summaries for lay audiences, along with feasibility considerations for HTA bodies, the SIP approach should support more meaningful patient involvement in HTAs.
FFQ, the primary method of dietary assessment in large-scale nutritional epidemiological studies, preclude an informed evaluation of the timing of dietary intake and meal-specific dietary intake. In this study, we developed the Meal-based Diet History Questionnaire (MDHQ), a self-administered questionnaire designed for estimating food and nutrient intakes for each meal type separately. The development was done based on a 16-d dietary record obtained from 242 Japanese adults. The MDHQ consisted of the three different parts, with a total of 196 items. Part 1 of the MDHQ asks about consumption frequency of generic food groups (n 24) for each meal type: breakfast, morning snack, lunch, afternoon snack, dinner and night snack. Part 2 of the MDHQ asks about relative consumption frequency of sub-food groups within one of the generic food groups which are asked in Part 1. Combining information derived from Parts 1 and 2 enables us to increase the number of foods we can estimate efficiently but within a limited number of questions. Part 3 of the MDHQ asks about general eating behaviours, which are intended to use in a variety of ways during dietary intake calculation. A series of calculation algorithms for food groups, energy and nutrients was also prepared. Given that the MDHQ was empirically developed based on comprehensive information on actual food consumption, this innovative tool may be promising for future epidemiological research on meal patterns and time of day of dietary intake, or chrono-nutrition research. A rigorous evaluation of validity of the MDHQ is warranted.
Involving patients is a core principle which governs the work of the National Institute for Health and Care Excellence (NICE). To improve how patient evidence is identified and considered in health technology assessments (HTAs), NICE worked with patient organizations to review existing HTA methods and co-designed proposals for change.
A working group, including six patient organizations, oversaw the project, identifying and co-designing options for improvement. We held a stakeholder event with twenty-two patient organizations to identify themes for improving how we find and use patient evidence. We then ran an online quantitative and qualitative survey for targeted consultation with patient organizations to capture broader views.
The fifty-two people who responded to the consultation made the following suggestions:
(i) Provide information about uncertainties that patient evidence might help to address;
(ii) Explore the role of real-world evidence in patient involvement;
(iii) Provide training and support to patient organizations;
(iv) Create inclusive committee cultures; and
(v) Include additional touchpoints during HTAs to incorporate patient evidence.
This work identified improvements in seeking and incorporating patient evidence into HTA processes. Precise guidance for patient organizations will help them to submit evidence that will make the most impact. This is particularly important when assessing disruptive technologies where there are likely to be greater uncertainties and cost pressures. The results of this work will be developed into formal options for NICE to consider when updating its methods guides.