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This chapter explores some issues having to do with levels in psychiatry and elsewhere in science. I distinguish among several different notions of level and discuss why talk of levels is sometimes useful in science, although it can also be a source of considerable confusion. I defend the claim that it is legitimate to think in terms of causal relations between levels (including so-called downward causation from upper to lower levels) against several recent criticisms, providing scientific example of when this motion seems appropriate.
Rapid diagnosis of dementia is essential to ensure optimum patient care. This study used real-world data to quantify the dementia diagnostic pathway in Australia.
A real-world, cross-sectional survey of physicians and patients.
Primary care or specialist physicians managing patients with cognitive impairment (CI).
Descriptive analyses focused on key events in the diagnostic pathway. Regression modeling compared the duration between first consultation and formal diagnosis with various factors.
Data for 600 patients were provided by 60 physicians. Mean time from initial symptoms to first consultation was 6.1 ± 4.4 months; 20% of patients had moderate or severe CI at first consultation. Mean time from first consultation to formal diagnosis was 4.0 ± 7.4 months (1.2 ± 3.6 months if not referred to a secondary physician, and 5.3 ± 8.3 months if referred). Time from first consultation to diagnosis was significantly associated with CI severity at first consultation; time was shorter with more severe CI. There was no association of disease severity and referral to a secondary physician; 69.5% of patients were referred, the majority (57.1%) to a geriatrician. The highest proportion of patients were diagnosed by geriatricians (47.4%). Some form of test or scale was used to aid diagnosis in 98.8% of patients.
A substantial number of Australians experience cognitive decline and behavioral changes some time before consulting a physician or being diagnosed with dementia. Increasing public awareness of the importance of early diagnosis is essential to improve the proportion of patients receiving comprehensive support prior to disease progression.
To sustainably improve cleaning of high-touch surfaces (HTSs) in acute-care hospitals using a multimodal approach to education, reduction of barriers to cleaning, and culture change for environmental services workers.
The study was conducted in 2 academic acute-care hospitals, 2 community hospitals, and an academic pediatric and women’s hospital.
Frontline environmental services workers.
A 5-module educational program, using principles of adult learning theory, was developed and presented to environmental services workers. Audience response system (ARS), videos, demonstrations, role playing, and graphics were used to illustrate concepts of and the rationale for infection prevention strategies. Topics included hand hygiene, isolation precautions, personal protective equipment (PPE), cleaning protocols, and strategies to overcome barriers. Program evaluation included ARS questions, written evaluations, and objective assessments of occupied patient room cleaning. Changes in hospital-onset C. difficile infection (CDI) and methicillin-resistant S. aureus (MRSA) bacteremia were evaluated.
On average, 357 environmental service workers participated in each module. Most (93%) rated the presentations as ‘excellent’ or ‘very good’ and agreed that they were useful (95%), reported that they were more comfortable donning/doffing PPE (91%) and performing hand hygiene (96%) and better understood the importance of disinfecting HTSs (96%) after the program. The frequency of cleaning individual HTSs in occupied rooms increased from 26% to 62% (P < .001) following the intervention. Improvement was sustained 1-year post intervention (P < .001). A significant decrease in CDI was associated with the program.
A novel program that addressed environmental services workers’ knowledge gaps, challenges, and barriers was well received and appeared to result in learning, behavior change, and sustained improvements in cleaning.
Psychological therapy groups for people in adult mental health services can relieve waiting list pressures and potentially reduce stigma and social isolation. Compassion-focused therapy (CFT) focuses on shame and self-criticism. The aim of this study was to evaluate a transdiagnostic CFT group.
Quantitative and qualitative data were obtained from 13 people who completed the group.
Participants completed a range of pre- and post-group self-report outcome measures that assess self-criticism and self-compassion.
Statistically significant improvements were found on all measures used, suggesting that attending the CFT group did result in meaningful changes. People who completed the group also provided positive feedback about the experience.
The results suggest that running CFT groups is feasible and acceptable to clients with a range of psychiatric diagnoses as part of their care from community mental health teams. People who completed the group demonstrated significant improvements. A proportion of people did not complete the group, and more research is required about the reasons for this. Limitations of this study are considered together with future directions for research into CFT.
In this chapter we shall explore how best to put theology to use when considering the nature of age and ageing in both ourselves and other people. The main body of this chapter consists of sketching out the shape of how theology might hold a number of important questions in order to both imagine age and seek a deeper and more insightful sense of the role of older people in both church and society (Woodward 2008). It continues a significant theme of this volume which is, that in imagining age, we cannot claim any complete or absolute framework of theology. Rather, these questions are scaffolding that support an exploration of how theology might be put to work in relation to our growing older. I begin with a story from my own experience. The reader is invited to enter imaginatively into this short narrative. This is followed by an intriguing extract from an interview with Carl Gustav Jung, which acts as a starting point for considering what we believe might help good ageing.
Who Is That in My Mirror?
I used to live in an affluent part of the West Midlands in the United Kingdom. Solihull was a borough full of affluent communities housing high achievers. The culture was busy, demanding and life could be stressful for these families. For some, the constant activity was chosen but for many it was deeply woven into the fabric of modern life. The constant flow of information and the need to be always on the move have the power to both satisfy and frustrate. In this culture, age and ageing have been marginalised such that older people seem not to be part of it.
Let me take you back to the local town where I shopped, or rather drove through, on my way to somewhere else. I am late for a meeting in Birmingham and I cannot find my mobile phone to let my colleagues know that I am behind. I negotiate a busy junction and then meet a pedestrian crossing. There are three cars in front of mine. My eyes catch the sight of an old man waiting to cross. He hesitates and then moves back while none of the cars ahead let him pass. I decide to let him cross even as my anxiety levels about the meeting continue to rise.
This essay discusses and criticizes the claim that normative political theory can
be (justifiably and fruitfully) divided into two parts—a part having
to do with ideal theory which assumes full compliance and abstracts away from
issues having to do with implementation and, contrasting with this, a nonideal
part having to do with implementation and with rules and institutions
appropriate for conditions of partial compliance. On this conception of ideal
theory, empirical facts about human behavior and motivation, connected to issues
surrounding compliance and implementation, are irrelevant to ideal theory,
although such facts can be relevant to the nonideal part of normative theory. I
argue against this conception, holding instead that such empirical facts are
relevant to most or all of normative political theory, including
“fundamental” normative principles.
Environmental and animal studies are rapidly growing areas of interest across a number of disciplines. Natures of Africa is one of the first edited volumes which encompasses transdisciplinary approaches to a number of cultural forms, including fiction, non-fiction, oral expression and digital media. The volume features new research from East Africa and Zimbabwe, as well as the ecocritical and eco-activist ‘powerhouses’ of Nigeria and South Africa. The chapters engage one another conceptually and epistemologically without an enforced consensus of approach. In their conversation with dominant ideas about nature and animals, they reveal unexpected insights into forms of cultural expression of local communities in Africa. The analyses explore different apprehensions of the connections between humans, animals and the environment, and suggest alternative ways of addressing the challenges facing the continent. These include the problems of global warming, desertification, floods, animal extinctions and environmental destruction attendant upon fossil fuel extraction. There are few books that show how nature in Africa is represented, celebrated, mourned or commoditised. Natures of Africa weaves together studies of narratives – from folklore, travel writing, novels and popular songs – with the insights of poetry and contemporary reflections of Africa on the worldwide web. The chapters test disciplinary and conceptual boundaries, highlighting the ways in which the environmental concerns of African communities cannot be disentangled from social, cultural and political questions. This volume draws on and will appeal to scholars and teachers of oral tradition and indigenous cultures, literature, religion, sociology and anthropology, environmental and animal studies, as well as media and digital cultures in an African context.
Fossil bone microanalyses reveal the ontogenetic histories of extinct tetrapods, but incomplete fossil records often result in small sample sets lacking statistical strength. In contrast, a histological sample of 50 tibiae of the hadrosaurid dinosaur Maiasaura peeblesorum allows predictions of annual growth and ecological interpretations based on more histologic data than any previous large sample study. Tibia length correlates well (R2>0.9) with diaphyseal circumference, cortical area, and bone wall thickness, thereby allowing longitudinal predictions of annual body size increases based on growth mark circumference measurements. With an avian level apposition rate of 86.4 μm/day, Maiasaura achieved over half of asymptotic tibia diaphyseal circumference within its first year. Mortality rate for the first year was 89.9% but a seven year period of peak performance followed, when survivorship (mean mortality rate=12.7%) was highest. During the third year of life, Maiasaura attained 36% (x=1260 kg) of asymptotic body mass, growth rate was decelerating (18.2 μm/day), cortical vascular orientation changed, and mortality rate briefly increased. These transitions may indicate onset of sexual maturity and corresponding reallocation of resources to reproduction. Skeletal maturity and senescence occurred after 8 years, at which point the mean mortality rate increased to 44.4%. Compared with Alligator, an extant relative, Maiasaura exhibits rapid cortical increase early in ontogeny, while Alligator cortical growth is much lower and protracted throughout ontogeny. Our life history synthesis of Maiasaura utilizes the largest histological sample size for any extinct tetrapod species thus far, demonstrating how large sample microanalyses strengthen paleobiological interpretations.
Focuses on the ways African theatre and performance relate to various kinds of media. Includes contributions on dance; popular video, with an emphasis on video drama and soaps from Eastern and Southern Africa, and the Nigerian 'Nollywood' phenomenon; the interface between live performance and video (or still photography), and links between on-line social networks and new performance identities. As a group the articles raise, from original angles, the issues of racism, gender, identity, advocacy and sponsorship. Volume Editor: DAVID KERR is Professor of English in the University of Botswana, and is the author of 'African Popular Theatre'. Series Editors: Martin Banham, Emeritus Professor of Drama & Theatre Studies, University of Leeds; James Gibbs, Senior Visiting Research Fellow, University of the West of England; Femi Osofisan, Professor at the University of Ibadan; Jane Plastow, Professor of African Theatre, University of Leeds; Yvette Hutchison, Associate Professor, Department of Theatre & Performance Studies, University of Warwick.