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In his intemperate and inaccurate review of Ralph Fiennes’s film of Coriolanus (2011) – throughout he calls Caius Martius ‘Gaius Marcius’ – Laremy Legel asserts that Jacobean English and present-day settings can never comfortably cohabit: ‘Shakespeare’s language mixed with a “modern” update can’t help but lead to tonal problems, pacing problems, and relevancy problems.’2 The bit between his teeth, Legel presses on: ‘modern takes on Shakespeare that leave the original language untouched are just massively out of place in modern cinema’. Such a sweeping and condemnatory generalization would disqualify some of the most creative cinematic re-imaginings of Shakespeare’s work, including Fiennes’s Coriolanus, Baz Luhrmann’s Romeo + Juliet (1996) and Joss Whedon’s Much Ado about Nothing (2013), and – needless to say – would, by implication, suggest that theatrical stagings of Shakespearian works that are not costumed in doublet-and-hose are guilty of similar flaws.
We report electroencephalography (EEG) results from a non-patient pilot study conducted whilst developing a neuromodulation approach for improving visual spatial working memory (vSWM) in people with schizophrenia. Working memory impairments are common in people with schizophrenia yet respond poorly to current drug treatments. Transcranial magnetic stimulation (TMS), a minimally-invasive, well-tolerated, brain stimulation technique that is performed whilst a person is awake and alert, may improve working memory performance. However, results have been inconsistent, possibly because TMS was delivered during the heterogenous “resting-state”. We delivered TMS to left dorsolateral prefrontal cortex time-locked to specific events in a vSWM task, aiming to modulate functional networks involved in encoding spatial data into working memory.
Each trial in the vSWM task started with a 2-second-long sample display containing either three or four coloured circles positioned at random locations. This was followed by a 2-second delay period. At the end of the delay period, a visual cue appeared, indicating the target colour. Participants moved a crosshair to the screen location where the target had appeared. We recorded 64-channel EEG throughout. In Experiment 1, twelve participants completed three- and four-item task versions. In Experiment 2, eighteen participants completed the four-item task in three separate blocks within a single session. Between blocks, they completed a short task version alongside TMS. TMS (intermittent theta burst stimulation, 600 pulses, 3.3 minutes) was delivered over the F3 electrode position. Each stimulation on-phase was synchronised to coincide with the onset of sample display. In a random order, one TMS block was active, and one was sham (90° coil rotation).
In Experiment 1, EEG showed decreases (“desynchronisation”) in beta (13–30 Hz) power during sample display and increases (“synchronisation”) during the delay period. Both effects were greater in the four-item condition, and in posterior electrodes. In Experiment 2, posterior beta desynchronisation during sample display was greater following either active or sham stimulation. However, synchronisation during the delay period reduced following sham and increased only following active stimulation. Likewise, performance declined following sham but remained stable or improved following active stimulation.
We examined the effects of TMS on electrophysiological signals evoked during a spatial working memory task. We found that beta-band oscillatory activity, thought to safeguard stored information during memory delays, was increased by memory load and maintained or restored in blocks following active TMS. These effects were greatest over parietal/occipital areas. It is suggested that this beta activity serves to protect memory traces from distractors (in the current case, internal distractors). Notably, if TMS enhances delay activity within areas of the brain involved in stimulus representation that are distal from the stimulation site, then its effects are best understood as network level modulations of brain activity.
Road traffic injuries (RTIs) are the largest individual contributor to the global burden of injury and were among the five leading causes of global disability-adjusted life years (DALYs) in 2016. In regions with limited emergency medical services, training lay first responders (LFRs) has been shown to increase availability of prehospital care for RTIs, but sustainable mechanisms to scale these programs remain unstudied.
Using a training of trainers (TOT) model, a six-hour LFR training program was launched in Lagos, Nigeria. The course was taught in a hybrid fashion with primary didactics over Zoom and practical in-person breakout sessions. Thirty TOTs proceeded to train 350 transportation providers as LFRs over one month. A previously validated, 23 question, pre-/post- assessment was administered digitally to assess knowledge acquisition. Participants responded to five-point Likert survey assessing instruction quality and post-course confidence.
TOTs scored a median of 56.5% (IQR: 43.5%, 71.7%) and 91.3% (IQR: 88.0%, 95.7%) on the pre- and post-assessments, respectively, with bleeding control scores increasing most (+69.4%). Course trainees scored a median of 34.8% (IQR: 26.0%, 43.5%) and 73.9% (IQR: 65.2%, 82.6%) on the pre- and post-assessments, respectively, with airway and breathing increasing most (+48.6%). All score increases were statistically significant with p<0.001 and did not differ by trainer. Participants rated confidence 5/5 (IQR: 5,5) in first aid skills and 5/5 (IQR: 4,5) in emergency transportation, increasing from pre-course confidences of 3/5 (IQR: 3,4) and 4/5 (IQR: 3,5), respectively (p<0.001). Participants rated the quality of education content and TOT instructors to be 5/5 (IQR:5,5).
This is the first time the efficacy of digital instruction for first responder trainers in LMICs has been investigated and demonstrates knowledge acquisition equivalent to that of prior in-person courses. Future work will examine the cost-effectiveness of the training of LFRs and the effect of LFRs on trauma outcomes.
Fifty years after its introduction, the American Psychiatric Association’s (APA) Goldwater Rule remains contentious, prohibiting member-psychiatrists from providing mental health commentary on individuals they have not treated and where they lack consent. Whilst its resonance extends beyond the United States, there is limited awareness about the Goldwater Rule’s applicability elsewhere, notably within Europe.
In 2022, we investigated whether the European Psychiatric Association’s (EPA) forty-four National Psychiatric Association Members (NPAs) had similar guidelines to the Goldwater Rule or comparable ethical positions around media and public commentary. We initially searched NPA websites and subsequently contacted NPAs via email and phone. Findings were coded to four categories: “NPA-level rules or position”, “No NPA-level rules orposition but noted country-level rules”, “No NPA-level rules or position and did not note country-level rules”, and “No response”.
n=27 NPAs had relevant web materials or replied to our correspondence (61.3% of total NPAs). From these 27, based on our interpretation, n=6 (22.2%) had rules or positions, n=6 (22.2%) indicated that country-level rules existed, and n=15 (55.5%) did not have applicable NPA-level or country-level regulations.
A sizeable proportion of NPAs included in our study have not yet formally developed or considered ethical issues addressed by the Goldwater Rule and psychiatric commentary on an individual’s psychopathology. Accordingly, the EPA could consider broader discussions about this, accounting for national traditions and sociocultural aspects of clinical practice. These could integrate the advantages and disadvantages of the APA’s rubric towards an evolved ethical debate.
The developmental absence (agenesis) of the corpus callosum (AgCC) is a congenital brain malformation associated with risk for a range of neuropsychological difficulties. Inhibitory control outcomes, including interference control and response inhibition, in children with AgCC are unclear. This study examined interference control and response inhibition: 1) in children with AgCC compared with typically developing (TD) children, 2) in children with different anatomical features of AgCC (complete vs. partial, isolated vs. complex), and 3) associations with white matter volume and microstructure of the anterior (AC) and posterior commissures (PC) and any remnant corpus callosum (CC).
Participants were 27 children with AgCC and 32 TD children 8–16 years who completed inhibitory control assessments and brain MRI to define AgCC anatomical features and measure white matter volume and microstructure.
The AgCC cohort had poorer performance and higher rates of below average performance on inhibitory control measures than TD children. Children with complex AgCC had poorer response inhibition performance than children with isolated AgCC. While not statistically significant, there were select medium to large effect sizes for better inhibitory control associated with greater volume and microstructure of the AC and PC, and with reduced volume and microstructure of the remnant CC in partial AgCC.
This study provides evidence of inhibitory control difficulties in children with AgCC. While the sample was small, the study found preliminary evidence that the AC (f2=.18) and PC (f2=.30) may play a compensatory role for inhibitory control outcomes in the absence of the CC.
Prince D.M. Pozharskii, who together with Kuz΄ma Minin helped to end the Time of Troubles in 1612-13, has been the focus of commemoration for centuries and has come to symbolize the defense of the Russian nation. This article focuses on three moments of his commemoration in the nineteenth century: the classical Pozharskii, as seen in the monument on Red Square, the nationalist Pozharskii, which reimagined him almost as a saint of the nation, and the regionalist Pozharskii, which presented him as a heroic forerunner of the zemstvo and the self-directed action of the Russian people. Using a wide variety of sources, the article shows how Pozharskii's grave and its commemoration were the focus of contention over what the Russian nation was and ought to be: composed of loyal and unquestioning subjects of the tsars, saint-like warriors, or a people that was self-governing at the local level. It also argues for the importance of including local narratives and sources in the historical narrative, as this was where the demand for self-government was most clearly made. Dead bodies can spark lively discussions, and when the body is Pozharskii's, the stakes can be as high as the meaning of the Russian nation itself.
This paper proposes a framework for comprehensive, collaborative, and community-based care (C4) for accessible mental health services in low-resource settings. Because mental health conditions have many causes, this framework includes social, public health, wellness and clinical services. It accommodates integration of stand-alone mental health programs with health and non-health community-based services. It addresses gaps in previous models including lack of community-based psychotherapeutic and social services, difficulty in addressing comorbidity of mental and physical conditions, and how workers interact with respect to referral and coordination of care. The framework is based on task-shifting of services to non-specialized workers. While the framework draws on the World Health Organization’s Mental Health Gap Action Program and other global mental health models, there are important differences. The C4 Framework delineates types of workers based on their skills. Separate workers focus on: basic psychoeducation and information sharing; community-level, evidence-based psychotherapeutic counseling; and primary medical care and more advanced, specialized mental health services for more severe or complex cases. This paper is intended for individuals, organizations and governments interested in implementing mental health services. The primary aim is to provide a framework for the provision of widely accessible mental health care and services.
Patients with neuropathic pain are heterogeneous in pathophysiology, etiology, and clinical presentation. Signs and symptoms are determined by the nature of the injury and factors such as genetics, sex, prior injury, age, culture, and environment. Basic science has provided general information about pain etiology by studying the consequences of peripheral injury in rodent models. This is associated with the release of inflammatory cytokines, chemokines, and growth factors that sensitize sensory nerve endings, alter gene expression, promote post-translational modification of proteins, and alter ion channel function. This leads to spontaneous activity in primary afferent neurons that is crucial for the onset and persistence of pain and the release of secondary mediators such as colony-stimulating factor 1 from primary afferent terminals. These promote the release of tertiary mediators such as brain-derived neurotrophic factor and interleukin-1β from microglia and astrocytes. Tertiary mediators facilitate the transmission of nociceptive information at the spinal, thalamic, and cortical levels. For the most part, these findings have failed to identify new therapeutic approaches. More recent basic science has better mirrored the clinical situation by addressing the pathophysiology associated with specific types of injury, refinement of methodology, and attention to various contributory factors such as sex. Improved quantification of sensory profiles in each patient and their distribution into defined clusters may improve translation between basic science and clinical practice. If such quantification can be traced back to cellular and molecular aspects of pathophysiology, this may lead to personalized medicine approaches that dictate a rational therapeutic approach for each individual.
In the general population, irritability is associated with later depression. Despite irritability being more prevalent in autistic children, the long-term sequelae are not well explored. We tested whether irritability in early childhood predicted depression symptoms in autistic adolescents, and whether associations could be explained by difficulties in peer relationships and lower educational engagement. Analyses tested the longitudinal associations between early childhood irritability (ages 3–5) and adolescent depression symptoms (age 14) in a prospective inception cohort of autistic children (N = 390), followed from early in development shortly after they received a clinical diagnosis. Mediators were measured in mid-childhood (age 10) by a combination of measures, from which latent factors for peer relationships and educational engagement were estimated. Results showed early childhood irritability was positively associated with adolescent depression symptoms, and this association remained when adjusting for baseline depression. A significant indirect pathway through peer relationships was found, which accounted for around 13% of the association between early childhood irritability and adolescent depression, suggesting peer problems may partially mediate the association between irritability and later depression. No mediation effects were found for education engagement. Results highlight the importance of early screening and intervention for co-occurring irritability and peer problems in young autistic children.
Open-ended methods that elicit willingness-to-pay (WTP) in terms of absolute dollars often result in high rates of questionable and highly skewed responses, insensitivity to changes in health state, and raise an ethical issue related to its association with personal income. We conducted a 2x2 randomized trial over the Internet to test 4 WTP formats: 1) WTP in dollars; 2) WTP as a percentage of financial resources; 3) WTP in terms of monthly payments; and 4) WTP as a single lump-sum amount. WTP as a percentage of financial resources generated fewer questionable values, had better distribution properties, greater sensitivity to severity of health states, and was not associated with income. WTP elicited on a monthly basis also showed promise.
When survey respondents rate the quality of life (QoL) associated with a health condition, they must not only evaluate the health condition itself, but must also interpret the meaning of the rating scale in order to assign a specific value. The way that respondents approach this task depends on subjective interpretations, resulting in inconsistent results across populations and tasks. In particular, patients and non-patients often give very different ratings to health conditions, a discrepancy that raises questions about the objectivity of either groups’ evaluations. In this study, we found that the perspective of the raters (i.e., their own current health relative to the health conditions they rated) influences the way they distinguish between different health states that vary in severity. Consistent with prospect theory, a mild and a severe lung disease scenario were rated quite differently by lung disease patients whose own health falls between the two scenarios, whereas healthy non-patients, whose own health was better than both scenarios, rated the two scenarios as much more similar. In addition, we found that the context of the rating task influences the way participants distinguish between mild and severe scenarios. Both patients and non-patients gave less distinct ratings to the two scenarios when each were presented in isolation than when they were presented alongside other scenarios that provided contextual information about the possible range of severity for lung disease. These results raise continuing concerns about the reliability and validity of subjective QoL ratings, as these ratings are highly sensitive to differences between respondent groups and the particulars of the rating task.
Understanding the combined effects of multi-parasite infections on their hosts is necessary for documenting parasite impacts and is particularly important for developing effective management strategies for economically important organisms. The white shrimp Penaeus setiferus supports important recreational and commercial fisheries along the southeastern and Gulf coasts of the United States and occupies an important ecological niche in estuarine and offshore habitats throughout these regions. The goal of this study was to identify and assess ontogenetic and spatial variation in white shrimp parasite communities and their relation to shrimp health. We used a series of trawl surveys in tidal creek and open water habitats of an estuary in the southeastern USA to collect and identify parasites of white shrimp using morphological and DNA sequencing techniques. Parasite communities in white shrimp were composed of organisms belonging to 6 classes: Conoidasida (gregarines), Oligohymenophorea (apostome and sessilid ciliates), Microsporea (meiodihaplophasids), Chromadorea (rhabditids), Cestoda (cyclophyllideans, lecanocephalideans and trypanorhynchs) and Trematoda (plagiorchiids). Parasite communities differed significantly among white shrimp life stages and localities. Furthermore, the health condition known as black gill occurred in some shrimp and was significantly related to parasite community structure. Infection metrics for the apostome ciliate Hyalophysa lynni, the trypanorhynch larvae Prochristianella sp. and the rhabditid larvae Hysterothylacium sp. were significantly different between shrimp exhibiting and not exhibiting black gill. These results highlight the importance of understanding parasite communities and the potential interactive effects of multiple parasite infections on shrimp health.
One of the most astonishing paradoxes in modern military history is the fact that, during the Second World War, the extreme racist SS organisation engendered an army, which was possibly the most multi-ethnic and transnational army that the twentieth century ever witnessed. This was brought about by the establishment of a military branch of the SS, the Waffen-SS. During its existence, it expanded from a modest bodyguard at Hitler's disposal to a mass army through whose ranks passed more than a million men. Until the outbreak of war, the SS maintained high standards as to personnel, who were all volunteers. Not only did they have to meet tough physical and racial demands; by joining, they also entered a Nazi order of warriors demanding absolute faith in Hitler, unconditional subordination and profound ideological dedication as the pillars of their martial calling.
The head of the SS, the Reichsfu?hrer-SS Heinrich Himmler, envisaged an e?lite force of devoted Nazis, who would alternate between active duty in the field and other kinds of SS activities. They were not only to be soldiers but also role models leading a life as wholly dedicated SS men. They were to let their identity as members of the ‘order’ permeate all their doings including choice of spouse, reproduction, interior decoration of their homes, and celebration of red-letter days. Himmler hoped to create an elite of committed Nazis, welded together in a loyal brotherhood and hardened through war into merciless individuals, who would pitilessly annihilate the Third Reich's real and alleged enemies; be they hostile troops, Jews, mentally ill or any other so-called sub-humans.
While, until the outbreak of war, this order remained relatively homogeneous, the situation changed markedly during the war. Now, the SS began to moderate the demands on race and physical capability, introduced conscription and started to recruit from all over Europe. With these changes, the SS got new recruits, for example, from Norway, who were often as ideologically zealous as were the original German members. However, men who merely wished to avoid forced labour or were pressured into signing up also joined the ranks – individuals, who might not have heard of the SS before, now saw themselves in the uniform of this organisation. Additionally, there were hundreds of thousands of recruits from ethnic groups, whom the SS would never have admitted before the war.
In March 1945, an American interrogation officer asked Unterscharführer Kurt Kretschmer of Division Das Reich about his division's massacres and other atrocities in Southern France. He replied, ‘I do not know what happened, I was not there.’ The scope of the Nazi crimes made the investigation and prosecution gigantic tasks. In many cases ‘a perfect crime’ was at hand. Apart from the perpetrators, there were hardly any surviving witnesses. But even if evidence was extant it was uncertain that this would fall into the hands of the prosecutors and the judges. In the early processes, the war and the chaos of the times were still so close that the prosecution lacked a proper survey and the knowledge that later historical research based on archival material has been able to provide. Under these conditions, the perpetrators had an opportunity of lying their way out of their complicity in a way that would not be possible today.
Apart from being faced with an enormous burden of investigation, the Allies were hampered by big politics and the economic and military interests. In many cases, political-pragmatic considerations took precedence over the judicial processes. Therefore, the prosecution of the Nazi henchmen was imperfect in more than one way. First, because some sentences were passed on the basis of limited investigation and documentation. Secondly, because of limited resources or political consideration, many perpetrators were either not prosecuted at all, had very mild sentences or were granted amnesties.
The Sentence at Nuremberg
In November 1945, in the South-German city of Nuremberg, the Allies started the legal reckoning with the Nazi top tier. Over the following year, not only 22 surviving top Nazis but also the entire administrative and political system constructed by the Nazis, were being prosecuted. The tribunal had the authority to sentence whole institutions and organisations as criminals. The reason for this was to ease later prosecution of individual persons; hence the membership of such bodies would in itself become a criminal act. From 1 September to 1 October 1946, the sentences were passed: 12 death sentences, seven imprisonments and three acquittals, the NSDAP, the Gestapo, the SD and the SS were declared criminal organisations.
Along with other SS organisations, the Waffen-SS was dealt with in this sentence. In their testimonies, General Hausser and others tried to convince the court that the Waffen-SS was the fourth service of the Wehrmacht, completely separate from the SS.
It was far from all SS soldiers who were prepared to die for Hitler and Nazism. In March 1945, the western Allies crossed the Rhine, and the following month the Soviet offensive against Berlin was launched. No one doubted any longer that the downfall of the Third Reich was imminent. Thus, as a soldier of the Reich one might choose to go down with the regime or try to survive either by surrendering oneself to the Allies or by deserting.
During the last days of the war, the German SS men fought primarily in their own country and might hope to return to civilian life when the war was over. The foreign Waffen-SS soldiers’ situation was different; many of them would be facing trial in their home countries. Nonetheless, many perceived prosecution at home as preferable compared to falling into the hands of the Red Army, for example by seeking refuge in the remaining embassies in Berlin, such as the Danish and Swedish. These endeavours were not particularly successful, but many succeeded in avoiding capture in various other ways. From the eastern shores of the Baltic Sea, Baltic Waffen-SS soldiers got across to the Swedish coast or to Denmark and mixed with refugees. At the moment of surrender, other non-German SS men hurried into civvies pretending to be forced labourers, or they hid with friends, family, or girlfriends.
The extent to which the former SS soldiers managed to hide may be illustrated by the case of the 1st SS brigade. During post-war legal processes in West Germany, almost 1,000 former members of the unit were asked about their spell as prisoners-of-war, and it turned out that 10 per cent had completely avoided incarceration. Considering their war record as continuous participants in genocide it comes as no surprise that former members of the 1st SS brigade would do whatever it took to evade captivity. Those who, like the 1st SS brigade, belonged among the very worst henchmen of the Holocaust, were of course especially tempted to try to assume new identities during their imprisonment or simply lie low vis-à-vis the victors. Through listening to radio, Allied broadcasts, or the Nazis’ own propaganda, there was an awareness that the Allies had an ambitious agenda of bringing Nazi culprits to justice and that SS men were very much in the allied spotlight.
The ideological SS universe helps us better understand the actions of the SS men, including the way they rationalized their war crimes and atrocities – a theme we will return to in a later chapter on Waffen-SS atrocities. The question of how ideology influenced and shaped practice at the front is, however, broader and even more complex as we shall see in the following.
Racial Differentiation at the Front
Moving eastwards, the soldiers of the Third Reich faced various ethnic groups which caused countless ideologically motivated reactions among the Waffen-SS men. In October 1941, for example, a Norwegian soldier in the Wiking division informed in a letter that he had lately been guarding POWs, most of whom were Ukrainians. Among these, he found that there was “much strangeness to behold” and continued:
Here were the most peculiar, diverse and ugly characters I have ever met. Occasionally one would encounter a fair-skinned Germanic type (maybe a descendant of a Norwegian Viking?). Otherwise, mainly small, black, unassuming men. Especially those representing the Asiatic Mongol type were a hideous lot.
A report from the second SS Cavalry Regiment August 1941 on the massacre in the Pripet Marshes also made a point of distinguishing different groups from each other. Here, the Ukrainians made a relatively good impression: ‘although they were small, they all were of a harmonious figure and build and had a clear look’. As was the case in the Pripet Marshes, such race evaluations could have drastic consequences for the locals. An order from Himmler's personal command staff stated that areas populated by völkisch Germans or Ukrainians, where they did not like the Poles and the Russians, were to be protected. Conversely, where the population was friendly towards the Poles or were ‘racially and humanly inferior’ everyone under suspicion of supporting partisans should be shot and their villages torched. Thus, in this and similar cases a racial distinction was made between the so-called sub-humans and those who might not be Volksdeutsche or Germanic, but were deemed racially acceptable to a degree where their lives were preserved.
Naturally, racial differentiation also applied to the SS internally. In the summer of 1943, for instance, general Steiner instructed his armoured corps to place emphasis on racial and physical appearance when selecting officer material.