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Public Health England published a report in 2017 on Obesity in Secure Mental Health units. A key finding of the review was that not only is obesity and overweight more prevalent in the population detained within mental health secure units (with rates of up to 80% reported) than in the general population (around 60%), patients appear to be more at risk of weight gain when detained. The report found evidence that there is a high risk of weight gain following admission, stemming from the combined effects of incarceration, ease of access to high calorific food, and the potential lack of access to recommended levels of physical activity. This project aims to; 1. Implement a traffic light system on food and confectionaries sold at the shop at a Medium secure hospital. 2. Provide healthier food options at the shop by using the traffic light system as a visual aid 3. To achieve weight reduction and promote healthy lifestyle choices in patients admitted to our medium secure Forensic unit.
1. Buying a new till system which is able to quantify what type of food is sold.
2. Labelling food sold using a traffic light system.
3. Calculate types of food sold following a three-month period after implementation.
1. Traffic light system provides a visual aid to patients in choosing healthier food.
2. Patients in our medium secure unit achieve a reduction in their weight.
3. Traffic light system can be replicated/ adopted by other secure hospitals.
The purpose of this research is to implement a traffic light system on food sold at a shop in our medium secure unit. It is hoped that by providing visual aids, patients have a means of easily identifying healthier food options. Choosing healthier food we hope will consequently result in weight reduction and overall improved lifestyle choices.
Initially criticized for its naïve representation of landscape features, Strauss's Alpensinfonie (1915) has in recent years been reinterpreted by scholars as a deliberate challenge to metaphysics, a late outgrowth of the composer's fascination with Nietzsche. As a consequence, the relationship between Strauss's tone poem and earlier artworks remains underexplored. Strauss in fact relied heavily on long-established tropes of representing mountain scenes, and when this work is situated against a backdrop of similarly themed Romantic paintings, literature, travelogues and musical compositions, many points of resemblance emerge. In this article, I focus on how human responses to mountains are portrayed within artworks. Romantic-era reactions were by no means univocal: mountains elicited overtly religious exhalations, atheistic refutations of all supernatural connections, pantheistic nature-worship, and also artworks which engaged with nature purely in an immanent fashion.
Strauss uses a range of strategies to distinguish the climber from the changing scenery he traverses. The ascent in the first half of Eine Alpensinfonie focuses on a virtuoso rendition of landscape in sound, interleaved with suggestions as to the emotional reactions of the protagonist. This immanent perspective on nature would accord well with Strauss's declared atheism. In the climber's response to the sublime experience of the peak, however, I argue that there are marked similarities to the pantheistic divinization of nature such as was espoused by the likes of Goethe, whom Strauss admired enormously. And while Strauss's was an avowedly godless perspective, I will argue in the final section of the article that he casts the climber's post-peak response to the sublime encounter in a parareligious light that again has romantic precedents. There are intimations of romantic transcendence in the latter part of the work, even if these evaporate as the tone poem, and the entire nineteenth-century German instrumental tradition it concludes, fades away into silence.
‘In the realm of ideas there are internal wars … during which everyone is declared traitor to his fatherland who does not publicly take one side or the other’. With these fighting words, Franz Liszt opened his polemical essay, ‘Berlioz and His “Harold” Symphony’ in 1855, an important salvo in an aesthetic debate now known as the ‘War of the Romantics’.1 This conflict blazed throughout the German-speaking lands in the period following the failed 1848–49 revolutions. It lasted for decades: an 1884 article by the participant journalist Richard Pohl noted that the ‘musical war’ had been going for thirty-two years and was not yet at an end. While his starting date is debatable, his characterisation of the ‘violence and bitterness’ with which it had initially been waged is right on the money.2 Savage polemics, sniping journalism and scandal-ridden performances were the norm throughout the 1850s and beyond, with the central issues of dispute being music’s relationship with other arts and the legitimacy of particular innovations in form, harmony and genre. Viewed with hindsight, these musical debates can be seen as symptoms of larger socio-political tensions in the second half of the nineteenth century, as the forces of progress and reaction clashed in a rapidly modernising Europe.
Social anxiety disorder (SAD) is common. It usually starts in adolescence, and without treatment can disrupt key developmental milestones. Existing generic treatments are less effective for young people with SAD than with other anxiety disorders, but an adaptation of an effective adult therapy (CT-SAD-A) has shown promising results for adolescents.
The aim of this study was to conduct a qualitative exploration to contribute towards the evaluation of CT-SAD-A for adoption into Child and Adolescent Mental Health Services (CAMHS).
We used interpretative phenomenological analysis (IPA) to analyse the transcripts of interviews with a sample of six young people, six parents and seven clinicians who were learning the treatment.
Three cross-cutting themes were identified: (i) endorsing the treatment; (ii) finding therapy to be collaborative and active; challenging but helpful; and (iii) navigating change in a complex setting. Young people and parents found the treatment to be useful and acceptable, although simultaneously challenging. This was echoed by the clinicians, with particular reference to integrating CT-SAD-A within community CAMHS settings.
The acceptability of the treatment with young people, their parents and clinicians suggests further work is warranted in order to support its development and implementation within CAMHS settings.
Notwithstanding their remarkable peculiarities and profoundly individual nature, Mahler’s symphonies were part of a tradition begun by Haydn, Mozart, and Beethoven; extended by Mendelssohn, Schumann, and Berlioz; and renewed during his lifetime by composers including Bruckner, Brahms, Bruch, Borodin, Tchaikovsky, Dvořák, Franck, Saint-Saëns, Elgar, Strauss, Sibelius, Nielsen, and Glazunov. This context is surveyed here in two periods: composers who flourished during Mahler’s youth roughly (1870–89) and those active from 1889 until the outbreak of World War I. The former period reveals that even within this relatively conservative choice of genre (vis-à-vis the symphonic poem) a remarkable of approach obtained, from the motivic integration of Brahms and the fragmented grandeur of Bruckner to the lyricism and user-friendly national influences of Dvořák and Tchaikovsky. In the later group, a trend toward amalgamation of programmatic and traditionally symphonic impulses becomes more pronounced, such as one finds in Mahler’s own works.
Three figures stand out as formative influences on the young Richard Strauss: his father, Franz, a hornist of conservative tastes; Hans von Bülow, a former Liszt pupil and recovering Wagnerian who was frequently at loggerheads with Franz; and Alexander von Ritter, another Liszt student who retained his passion for the music of the future when Bülow abjured it. From his father Strauss acquired a deep and abiding love of the music of classical and early romantic eras. From Bülow, to whom he was an assistant for a few months in 1885, he learned much about the art and craft of conducting. From Ritter, Strauss received a passionate induction into the progressive ideas of Liszt, Wagner, and Schopenhauer, which led to the composition of his early tone poems and his first opera, Guntram. Even though Strauss would eventually distance himself creatively from their advice, each contributed significantly to his artistic development.
Dinosaur body fossil material is rare in Scotland, previously known almost exclusively from the Great Estuarine Group on the Isle of Skye. We report the first unequivocal dinosaur fossil from the Isle of Eigg, belonging to a Bathonian (Middle Jurassic) taxon of uncertain affinity. The limb bone NMS G.2020.10.1 is incomplete, but through a combination of anatomical comparison and osteohistology, we determine it most likely represents a stegosaur fibula. The overall proportions and cross-sectional geometry are similar to the fibulae of thyreophorans. Examination of the bone microstructure reveals a high degree of remodelling and randomly distributed longitudinal canals in the remaining primary cortical bone. This contrasts with the histological signal expected of theropod or sauropod limb bones, but is consistent with previous studies of thyreophorans, specifically stegosaurs. Previous dinosaur material from Skye and broadly contemporaneous sites in England belongs to this group, including Loricatosaurus and Sarcolestes and a number of indeterminate stegosaur specimens. Theropods such as Megalosaurus and sauropods such as Cetiosaurus are also known from these localities. Although we find strong evidence for a stegosaur affinity, diagnostic features are not observed on NMS G.2020.10.1, preventing us from referring it to any known genera. The presence of this large-bodied stegosaur on Eigg adds a significant new datapoint for dinosaur distribution in the Middle Jurassic of Scotland.
‘[T]he greatest genius of our day & for many a long day past, Richard Strauss’
‘In my young days, there was a saying that went the rounds in music-loving circles: “If Richard, why not Wagner? If Strauss, why not Johann?” ‘
ON 24 June 1914 Richard Strauss was awarded an honorary doctorate in music by the University of Oxford. A month later, the outbreak of World War I led to the confiscation of the composer's considerable savings held in British banks (£37,000, equating to c. £1.5m today). The country that had honoured him as ‘the musician of our century or perhaps even of one to come’ also treated him as a representative of the enemy, with his works banned from performance during both World Wars. Musically if not financially, Britain subsequently made reparations to Strauss, most notably by honouring the composer with a festival of his music in 1947, two years before his death. This was the occasion of the last of Strauss's sixteen visits to Britain, a series that had begun exactly fifty years earlier. Even before 1897 Strauss's music had begun to be heard in metropolitan centres around the country, with the tone poems serving as bell-wethers for fierce debates over musical beauty, programme music and aesthetic modernity more generally. Strauss's visits generally centred around conducting engagements and in this role he was an effective propagandist for his own music, but his orchestral works were rewarding vehicles for many other conductors too. As a result, the tone poems soon became repertory staples in Britain in spite of their contested reception. In 1903 the first festival devoted to Strauss's music was held in London, evidence that even before his fortieth birthday he was recognised in Britain as one of the major musical voices of the age.
This chapter will delve into the contested early reception of Strauss's tone poems in Britain, looking at the cut and thrust of debates in contemporary concert reviews up to the 1903 festival. Early performances of the two tone poems that had their British premières after this date will also be examined, with particular consideration of how the Great War impacted on perceptions of Eine Alpensinfonie. The subsequent assimilation of the tone poems into the standard concert-hall repertory in the decades leading up to the 1947 festival will be traced more summarily.
Schizophrenia is associated with altered neural development. We assessed neurological soft signs (NSS) and dermatoglyphic anomalies (total a–b ridge count (TABRC) and total finger ridge count) in 15 pairs of twins concordant and discordant for schizophrenia. Within-pair differences in both NSS and TABRC scores were significantly greater in discordant compared to concordant monozygotic pairs. There was no significant difference in NSS and TABRC scores between subjects with schizophrenia and their co-twins without the illness. However, monozygotic discordant twins with schizophrenia had higher ABRCs on their right hands compared to their co-twins without the illness. These findings suggest that an unidentified environmental event acting between weeks 6 and 15 of gestation affects the development of monozygotic twins who go on to develop schizophrenia but does not have a corresponding effect on their co-twins who do not develop the illness. The effect of such an event on dermatoglyphic profiles appears lateralised to the right hand in affected twins.
In-patients in crisis report poor experiences of mental healthcare not conducive to recovery. Concerns include coercion by staff, fear of assault from other patients, lack of therapeutic opportunities and limited support. There is little high-quality evidence on what is important to patients to inform recovery-focused care.
To conduct a systematic review of published literature, identifying key themes for improving experiences of in-patient mental healthcare.
A systematic search of online databases (MEDLINE, PsycINFO and CINAHL) for primary research published between January 2000 and January 2016. All study designs from all countries were eligible. A qualitative analysis was undertaken and study quality was appraised. A patient and public reference group contributed to the review.
Studies (72) from 16 countries found four dimensions were consistently related to significantly influencing in-patients' experiences of crisis and recovery-focused care: the importance of high-quality relationships; averting negative experiences of coercion; a healthy, safe and enabling physical and social environment; and authentic experiences of patient-centred care. Critical elements for patients were trust, respect, safe wards, information and explanation about clinical decisions, therapeutic activities, and family inclusion in care.
A number of experiences hinder recovery-focused care and must be addressed with the involvement of staff to provide high-quality in-patient services. Future evaluations of service quality and development of practice guidance should embed these four dimensions.
Declaration of interest
K.B. is editor of British Journal of Psychiatry and leads a national programme (Synergi Collaborative Centre) on patient experiences driving change in services and inequalities.
Palaeochannels of lowland rivers provide a means of investigating the sensitivity of river response to climate-driven hydrologic change. About 80 palaeochannels of the lower Macquarie River of southeastern Australia record the evolution of this distributive fluvial system. Six Macquarie palaeochannels were dated by single-grain optically stimulated luminescence. The largest of the palaeochannels (Quombothoo, median age 54 ka) was on average 284 m wide, 12 times wider than the modern river (24 m) and with 21 times greater meander wavelength. Palaeo-discharge then declined, resulting in a younger, narrower, group of palaeochannels, Bibbijibbery (125 m wide, 34 ka), Billybingbone (92 m, 20 ka), Milmiland (112 m, 22 ka), and Mundadoo (86 m, 5.6 ka). Yet these channels were still much larger than the modern river and were continuous downstream to the confluence with the Barwon-Darling River. At 5.5 ka, a further decrease in river discharge led to the formation of the narrow modern river, the ecologically important Macquarie Marshes, and Marra Creek palaeochannel (31 m, 2.1 ka) and diminished sediment delivery to the Barwon-Darling River as palaeo-discharge fell further. The hydrologic changes suggest precipitation was a driving forcing on catchment discharge in addition to a temperature-driven runoff response.
Caring for someone with a mental illness is increasingly occurring within the community. As a result, family members who fulfil a caregiving role may experience substantial levels of burden and psychological distress. This study investigates the level of burden and psychological distress reported by caregivers after the patient's admission.
This study found that the overall level of burden and psychological distress experienced by caregivers did not differ according to the patient's legal status. However, the caregivers of those who were voluntarily admitted supervised the person to a significantly greater extent than the caregivers of those who were involuntarily admitted. Approximately 15% of caregivers revealed high levels of psychological distress.
This study may emphasise a need for mental health professionals to examine the circumstances of caregivers, particularly of those caring for patients who are voluntarily admitted, a year after the patient's admission.
Relatives of people with psychosis experience high levels of distress and require support. Family interventions have been shown to be effective in improving outcomes but are difficult to access and not suitable for all relatives.
To assess the feasibility and effectiveness of a supported self-management package for relatives of people with recent-onset psychosis.
A randomised controlled trial (n = 103) comparing treatment as usual (TAU) in early intervention services with TAU plus the Relatives' Education And Coping Toolkit (REACT) intervention (trial identifier: ISRCTN69299093).
Compared with TAU only, those receiving the additional REACT intervention showed reduced distress and increased perceived support and perceived ability to cope at 6-month follow-up.
The toolkit is a feasible and potentially effective intervention to improve outcomes for relatives. A larger trial is needed to reliably assess the clinical and cost-effectiveness of REACT, and its impact on longer-term outcomes.
Nicole Grimes, Marie Curie Fellow at University College Dublin (UCD), and the University of California,Siobhán Donovan, School of Languages and Literatures, University College Dublin (UCD),Wolfgang Marx, School of Music, University College Dublin (UCD)
Antonin Dvorak and Richard Strauss arm in arm—a right queer sight.
As an observer of late nineteenth-century Viennese cultural life, Eduard Hanslick towers above all other journalists and writers who attempted to map the changing face of music in this period. He has been typecast as the archenemy of musical progress, a foe to any who questioned the sacred tenets of “absolute” music, of which he was alleged to be a seminal theorist and tireless propagandist. His championing of Brahms, as guardian of what he considered the legitimate compositional tradition, is as celebrated as his opposition to Liszt, Wagner, and their ilk, is notorious. Even when it was fashionable to point up his short-sightedness in this latter area, Hanslick's critical pronouncements still continued to be invoked, arguably as much for their eloquence and acumen as out of the need to cite a representative view of misguided conservatism. As a result of the disciplinary upheavals which musicology has undergone over the last twenty-five years, Hanslick's star is again in the ascendant; his judgments have been rehabilitated and reopened to scrutiny in tandem with the dismantling of the idea of “musical progress” as an unquestioned article of faith. Reading through his concert reports offers a glimpse into the contested musical politics of the later nineteenth-century Germanic lands, a world in which old certainties were crumbling, with his being one of the few voices to offer a coherent aesthetic picture, albeit one shaped by certain contestable ideological premises.
“The Mannheim orchestra was very struck and astounded by the leap from my F minor Symphony to Macbeth,” reported Strauss after a rehearsal of the latter work in January, 1889. This astonishment is not to be wondered at: there is a profound stylistic gulf between the staid Classicism of Strauss's Second Symphony (which the orchestra performed under the composer's direction in October, 1885) and his first tone poem with its corrosive dissonances, structural freedoms, and, most obviously, its overt reference to extra-musical subject matter. In the interim, Strauss had been converted to a ‘totally new way” of composing, one inspired by Liszt and Wagner. While some of his earlier works display high levels of technical assurance, it was not until the first cycle of tone poems – Macbeth (1887–8, rev. 1891), Don Juan (1888), and Tod und Verklärung (1888–9) – that Strauss found a fully original voice. These three works mark the beginnings of an interest in poetic music that would dominate his output until the final decade of his life and would earn him widespread fame, even notoriety, throughout the German-speaking lands and beyond.
The heir to Liszt and Wagner
When Strauss took up his first professional engagement as assistant conductor to the gifted if irascible Hans von Bülow in October, 1885, he could not have foreseen how significantly this position would change his life. At that time, Strauss was in the grips of what he later called his Brahmsschwärmerei, a juvenile passion for Brahms, and shortly aft er arriving at Meiningen he met his idol, who encouraged him and gave him valuable advice. Yet this was not the encounter that Strauss would later describe as the “greatest event of the winter in Meiningen.”