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Background: Eye movements reveal neurodegenerative disease processes due to overlap between oculomotor circuitry and disease-affected areas. Characterizing oculomotor behaviour in context of cognitive function may enhance disease diagnosis and monitoring. We therefore aimed to quantify cognitive impairment in neurodegenerative disease using saccade behaviour and neuropsychology. Methods: The Ontario Neurodegenerative Disease Research Initiative recruited individuals with neurodegenerative disease: one of Alzheimer’s disease, mild cognitive impairment, amyotrophic lateral sclerosis, frontotemporal dementia, Parkinson’s disease, or cerebrovascular disease. Patients (n=450, age 40-87) and healthy controls (n=149, age 42-87) completed a randomly interleaved pro- and anti-saccade task (IPAST) while their eyes were tracked. We explored the relationships of saccade parameters (e.g. task errors, reaction times) to one another and to cognitive domain-specific neuropsychological test scores (e.g. executive function, memory). Results: Task performance worsened with cognitive impairment across multiple diseases. Subsets of saccade parameters were interrelated and also differentially related to neuropsychology-based cognitive domain scores (e.g. antisaccade errors and reaction time associated with executive function). Conclusions: IPAST detects global cognitive impairment across neurodegenerative diseases. Subsets of parameters associate with one another, suggesting disparate underlying circuitry, and with different cognitive domains. This may have implications for use of IPAST as a cognitive screening tool in neurodegenerative disease.
The Chevalier de la Charrette, it has long been recognised, is about delay – slow revelation, the postponement of meaning, the hiding of information about characters and their intents. This phenomenon owes a great deal to the elusive hero: not only does he famously hesitate to take a humiliating ride in the cart that gives him his nickname and the text its title, he is also repeatedly incognito, absent or paralysed either by indecision or love for Guinevere. Lancelot constitutes the ‘disappearing center’ of a narrative where many characters desire or quest for him. Contradictions accumulate around him, and he frequently experiences dilemmas before jumping to action. Both inscribed audiences and readers are led to ‘assess’ Lancelot – is he saviour or threat, good knight or bad? Lancelot's relationship with Guinevere also involves ambiguities, their eventual consummation shrouded in secrecy and misunderstanding, and both characters gesture towards, but ultimately avoid, the finality of martyrdom to love. More structurally, Lancelot's decisive face-off with Meleagant, tied to all possibility of justice, is long delayed, with several inconclusive fights. Eventually, Meleagant's defeat offers some closure, but the epilogue opens things up again, reawakening certain problems stemming from the opening (vague statements about authorship and patronage) and adding others (including the idea that a second author took over at an indeterminate point). Questions of interpretation and truth have therefore long dominated critical discussion, along with praise for the ‘art’ of the storyteller who wove this intriguing fabric.
I wish to argue that meaning in the Charrette is produced through contact between bodies. Narrative suspense is material and embodied, and the text's sophistication, I will contend, lies in its articulation of the physical as much as the psychological. The ‘art’ of the author manifests itself in the narration of battles, in a poetics of violence which has not been fully accounted for. I will therefore focus primarily on close reading the text's combat scenes, bringing out their evocation of a play of surfaces, including bodies (human, horse) and the objects that surround them (armour, lances, swords). Frequently, contact appears close, before being mediated, delayed, frustrated or inhibited.
Self-harm is a common presentation to acute hospitals, associated with increased risk of completed suicide. Safety plans are increasingly recommended to help patients recognise and prevent escalation of self-harm behaviours.
This project aimed to improve quality and documentation of safety planning for patients admitted at an acute general hospital due to self-harm, who were assessed by Liaison Psychiatry. We aimed to increase the number of patients given written safety plans on discharge by 50%.
The PDSA cycle model of quality improvement was used. A retrospective audit of clinical records was conducted over 3 months to establish baseline documentation of safety planning (n = 51). A template for a self-harm crisis plan, used in other areas of the Trust, was adopted, to be adapted to each patient. A leaflet for sources of crisis support and patient feedback form were developed and distributed to clinicians in the team. Data collection was repeated one month later (n = 48). The second set of interventions involved a training session for clinicians on developing safety plans in collaboration with patients, and a poster highlighting the process to be undertaken when discharging a patient admitted with self-harm.
Following initial interventions, 20% of patients had completed safety plans and 50% received advice, an increase of 20% and 40% respectively. The second PDSA cycle showed increase in numbers to 38% and 67% respectively.
Creating a crisis plan with a hospital-specific leaflet for the Liaison Psychiatry team increased the number of patients discharged with safety plans in place. 86% of patients who participated in safety-planning found the process helpful and felt likely to use the plan in future crises. This is an area of ongoing quality improvement which can be implemented in other hospitals to better equip patients with skills and support to reduce self-harm/suicide attempts.
Suicide plans and attempts rarely occur without prior suicidal ideation but are hard to predict. Early intervention efforts need to focus on subgroups of the population who are more likely to transition from ideation to suicidal plans and attempts. The current study utilised data from a large nationally representative sample to investigate the time taken to transition and the demographic and mental health correlates of transitioning to suicidal plans and attempts among those with suicidal ideation.
Data were from 1237 Australians aged 16–85 years who reported suicidal thoughts at some point in their life. Discrete time survival analysis was used to retrospectively examine the time in years and correlates of transitioning from suicidal ideation to suicide plans and suicide attempt.
The majority of those who transitioned to suicide plans or attempts typically did so within 2 years of first experiencing suicidal ideation. Several factors were independently associated with increased speed to transition, including alcohol use disorder, drug use disorder, major depressive episode, obsessive compulsive disorder, sexual minority status, and non-urban location. Older age, being male, older age of first ideation and greater family support were associated with a slower transition.
The current study suggests that pre-existing mental or substance use disorders, particularly drug use disorder, as well as sexual minority status, sex and greater family support play an important role in the transition from suicidal ideation to plans or attempts. These results highlight the potential importance of suicide prevention programs that aim to improve social connectedness.
Gravitational waves from coalescing neutron stars encode information about nuclear matter at extreme densities, inaccessible by laboratory experiments. The late inspiral is influenced by the presence of tides, which depend on the neutron star equation of state. Neutron star mergers are expected to often produce rapidly rotating remnant neutron stars that emit gravitational waves. These will provide clues to the extremely hot post-merger environment. This signature of nuclear matter in gravitational waves contains most information in the 2–4 kHz frequency band, which is outside of the most sensitive band of current detectors. We present the design concept and science case for a Neutron Star Extreme Matter Observatory (NEMO): a gravitational-wave interferometer optimised to study nuclear physics with merging neutron stars. The concept uses high-circulating laser power, quantum squeezing, and a detector topology specifically designed to achieve the high-frequency sensitivity necessary to probe nuclear matter using gravitational waves. Above 1 kHz, the proposed strain sensitivity is comparable to full third-generation detectors at a fraction of the cost. Such sensitivity changes expected event rates for detection of post-merger remnants from approximately one per few decades with two A+ detectors to a few per year and potentially allow for the first gravitational-wave observations of supernovae, isolated neutron stars, and other exotica.
Postprandial glycaemia and insulinaemia are important risk factors for type 2 diabetes. The prevalence of insulin resistance in adolescents is increasing, but it is unknown how adolescent participant characteristics such as BMI, waist circumference, fitness and maturity offset may explain responses to a standard meal. The aim of the present study was to examine how such participant characteristics affect the postprandial glycaemic and insulinaemic responses to an ecologically valid mixed meal. Data from the control trials of three separate randomised, crossover experiments were pooled, resulting in a total of 108 participants (fifty-two boys, fifty-six girls; aged 12·5 (SD 0·6) years; BMI 19·05 (SD 2·66) kg/m2). A fasting blood sample was taken for the calculation of fasting insulin resistance, using the homoeostatic model assessment of insulin resistance (HOMA-IR). Further capillary blood samples were taken before and 30, 60 and 120 min after a standardised lunch, providing 1·5 g/kg body mass of carbohydrate, for the quantification of blood glucose and plasma insulin total AUC (tAUC). Hierarchical multiple linear regression demonstrated significant predictors for plasma insulin tAUC were waist circumference, physical fitness and HOMA-IR (F(3,98) = 36·78, P < 0·001, adjusted R2 = 0·515). The variance in blood glucose tAUC was not significantly explained by the predictors used (F(7,94) = 1·44, P = 0·198). Significant predictors for HOMA-IR were BMI and maturity offset (F(2,102) = 14·06, P < 0·001, adjusted R2 = 0·021). In summary, the key findings of the study are that waist circumference, followed by physical fitness, best explained the insulinaemic response to an ecologically valid standardised meal in adolescents. This has important behavioural consequences because these variables can be modified.
Community forestry has long been regarded as a way to achieve the sustainable management of forest and tree resources while maximizing benefits for those responsible for the custodianship of natural resources. Throughout much of the developing world, forests and the lands they occupy have been increasingly ceded to the management and control of Indigenous peoples and local communities. In the post-conflict environment of Liberia, community forestry has been identified as a means of maximizing the engagement of local communities in forest management initiatives. Liberia’s recent comprehensive National Forestry Policy is an important step forward in this process. The new legislative framework makes it clear that a major reorientation of the forestry sector is required if it is to successfully address the economic challenges facing the country. These challenges concern the need to substantially improve forest governance and to ensure that the forest sector contributes more effectively to the alleviation of poverty and livelihood improvement. While, on paper, the legal framework for community forestry is robust, implementation is falling short due to conflicts over land and resources that have pervaded the Liberian forestry sector for decades. Increased investment in oil palm expansion, artisanal agriculture and broader government-supported logging activities all threaten the implementation of community forestry. Concomitantly, a fundamental lack of capacity at the community level and at the level of the Forestry Department has curtailed early attempts to operationalize community forestry in the country. In this chapter we explore the evolution and development of community forestry in Liberia, and assess prospects for its future implementation. We provide a clear framework of recommendations to address potential constraints to its success.
Vascular cognitive impairment (VCI) post-stroke is frequent but may go undetected, which highlights the need to better screen cognitive functioning following a stroke.
We examined the clinical utility of the Montreal Cognitive Assessment (MoCA) in detecting cognitive impairment against a gold-standard neuropsychological battery.
We assessed cognitive status with a comprehensive battery of neuropsychological tests in 161 individuals who were at least 3-months post-stroke. We used receiver operating characteristic (ROC) curves to identify two cut points for the MoCA to maximize sensitivity and specificity at a minimum 90% threshold. We examined the utility of the Symbol Digit Modalities Test, a processing speed measure, to determine whether this additional metric would improve classification relative to the MoCA total score alone.
Using two cut points, 27% of participants scored ≤ 23 and were classified as high probability of cognitive impairment (sensitivity 92%), and 24% of participants scored ≥ 28 and were classified as low probability of cognitive impairment (specificity 91%). The remaining 48% of participants scored from 24 to 27 and were classified as indeterminate probability of cognitive impairment. The addition of a processing speed measure improved classification for the indeterminate group by correctly identifying 65% of these individuals, for an overall classification accuracy of 79%.
The utility of the MoCA in detecting cognitive impairment post-stroke is improved when using a three-category approach. The addition of a processing speed measure provides a practical and efficient method to increase confidence in the determined outcome while minimally extending the screening routine for VCI.
There is a growing body of evidence highlighting the presence of a single general dimension of psychopathology that can account for multiple associations across mental and substance use disorders. However, relatively little evidence has emerged regarding the validity of this model with respect to a range of factors that have been previously implicated across multiple disorders. The current study utilized a cross-sectional population survey of adolescents (n = 2,003) to examine the extent to which broad psychopathology factors account for specific associations between psychopathology and key validators: poor sleep, self-harm, suicidality, risky sexual behavior, and low self-esteem. Confirmatory factor models, latent class models, and factor mixture models were estimated to identify the best structure of psychopathology. Structural equation models were then estimated to examine the broad and specific associations between each psychopathology indicator and the validators. A confirmatory factor model with three lower-order factors, representing internalizing, externalizing, and psychotic-like experiences, and a single higher-order factor evidenced the best fit. The associations between manifest indicators of psychopathology and validators were largely nonspecific. However, significant and large direct effects were found between several pairwise associations. These findings have implications for the identification of potential targets for intervention and/or tailoring of prevention programs.
There are few very brief measures that accurately identify multiple common mental disorders.
The aim of this study was to develop and assess the psychometric properties of a new composite measure to screen for five common mental disorders.
Two cross-sectional psychometric surveys were used to develop (n = 3175) and validate (n = 3620) the new measure, the Rapid Measurement Toolkit-20 (RMT20) against diagnostic criteria. The RMT20 was tested against a DSM-5 clinical checklist for major depression, generalised anxiety disorder, panic disorder, social anxiety disorder and post-traumatic stress disorder, with comparison with two measures of general psychological distress: the Kessler-10 and Distress Questionnaire-5.
The area under the curve for the RMT20 was significantly greater than for the distress measures, ranging from 0.86 to 0.92 across the five disorders. Sensitivity and specificity at prescribed cut-points were excellent, with sensitivity ranging from 0.85 to 0.93 and specificity ranging from 0.73 to 0.83 across the five disorders.
The RMT20 outperformed two established scales assessing general psychological distress, is free to use and has low respondent burden. The measure is well-suited to clinical screening, internet-based screening and large-scale epidemiological surveys.
Self-report scales that measure the severity of common mental disorders based on subjective signs and symptoms form a critical component in clinical psychology and psychiatry. There are numerous advantages of self-report scales, including increased efficiency with respect to costs and administration time as well as being amenable to electronic administration. However, there are several disadvantages, including susceptibility to nonoptimal response strategies and cross-cultural bias. The current chapter provides an overview of some of the more widely used self-report scales for depression and anxiety in research and clinical settings, with a specific focus on their psychometric properties and cross-cultural applicability. In addition, this chapter discusses the application of modern test theory to self-report scales for common mental disorders, with the aim of improving the reliability, validity, comparability, and efficiency of self-report data.
Pressure to increase food production grows with population growth. Agriculture dominates the global landscape, and more food is being produced than ever before. Yet, a large part of the population is undernourished. Concomitantly, much of the agricultural expansion related to achieving global food security is at the expense of forests ecosystems, critical for biodiversity and the provision of ecosystem services. SDG 2: Zero Hunger seeks to ‘End hunger, achieve food security and nutrition and promote sustainable agriculture’. This chapter explores the potential impacts of achieving SDG 2 on forests and forest-dependent people. It focuses on five of the SDG 2 targets that are closely entwined with forests and forest related livelihoods. It discusses how the current food system polarises food production and forest conservation, when in fact they should, and can, be harmonised. We conclude with observations on the potential trade-offs and synergies between SDG 2 and the other SDGs, emphasizing the need for integrated land use management.
Debating was an important part of schoolgirls’ political education in late Victorian and Edwardian England that has been overlooked in the scholarship on female education and civics instruction. Debates offered middle- and working-class schoolgirls an embodied and interactive education for citizenship. Considering both the content of discussions and the process of debating, this article argues that school debates provided a unique opportunity for girls to discuss political ideas and develop political skills. Debates became intertwined with girls’ peer cultures, challenging contemporary and historiographical assumptions of girlhood apoliticism. Positioning girls as political subjects sheds new light on political change in modern Britain. Schoolgirl debates show how gendered political boundaries were shifting in this period. Within the unique space of the school debating chamber, girls were free to appropriate and subvert ‘masculine’ political subjects and ways of speaking. In mock parliaments, schoolgirls re-created the archetypal male political space of the House of Commons, demonstrating their familiarity with parliamentary politics. Schoolgirl debates therefore foreshadowed initiatives that promoted women's citizenship after partial suffrage was achieved in 1918, and they help to explain how the first women voters were assimilated easily into existing party and constitutional politics.