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Thomas Adès is a dominant force in contemporary music, whose work attracts significant attention and acclaim, and has been performed by many renowned ensembles. This volume – the first to present a range of scholarly essays on every aspect of Adès's music – offers authoritative accounts of Adès's major compositions from a variety of analytical, critical, cultural and historical perspectives. The opening chapters focus on Adès's earlier music, offering close readings of key works. Further essays focus on his engagement with forms and instrumental genres. The final chapters turn to Adès's texted music and highlight how themes introduced in earlier chapters cut across Adès's entire output. Richly illustrated with musical examples and supported by further online material, this book provides a multi-faceted portrait of Adès's work that opens up new ways of thinking about, and engaging with, his music.
People with serious mental illness (SMI) have a significantly shorter life expectancy than the general population. This study investigates whether the mortality rate in this group has changed over the last decade.
Using Clinical Record Interactive Search software, we extracted data from a large electronic database of patients in South East London. All patients with schizophrenia, schizoaffective disorder or bipolar disorder from 2008 to 2012 and/or 2013 to 2017 were included. Estimates of life expectancy at birth, standardised mortality ratios and causes of death were obtained for each cohort according to diagnosis and gender. Comparisons were made between cohorts and with the general population using data obtained from the UK Office of National Statistics.
In total, 26 005 patients were included. In men, life expectancy was greater in 2013–2017 (64.9 years; 95% CI 63.6–66.3) than in 2008–2012 (63.2 years; 95% CI 61.5–64.9). Similarly, in women, life expectancy was greater in 2013–2017 (69.1 years; 95% CI 67.5–70.7) than in 2008–2012 (68.1 years; 95% CI 66.2–69.9). The difference with general population life expectancy fell by 0.9 years between cohorts in men, and 0.5 years in women. In the 2013–2017 cohorts, cancer accounted for a similar proportion of deaths as cardiovascular disease.
Relative to the general population, life expectancy for people with SMI is still much worse, though it appears to be improving. The increased cancer-related mortality suggests that physical health monitoring should consider including cancer as well.
Understanding the viewpoint of clinicians in a healthcare setting is a vital task to comprehend the success of patients undergoing physical rehabilitation. Addressing user experience is an essential activity which designers undertake when formulating product specifications at the early stages of product design. The involvement of clinicians during the product use-phase influences the progress and achievements attained by the patients throughout their rehabilitation journey. Several clinicians (n=16) were asked to participate in a qualitative study to evaluate the performance of different personae in activities of daily living. The experiences of patients who use rehabilitation products as part of their therapy session at the clinic were evaluated. Based on this evaluation, a set of clinician requirements were formulated to reflect the overall experience when using rehabilitation products. Understanding these requirements brought about several implications to be considered during the design cycle. Through these considerations and by adopting a user-centred design approach, designers are in a better position to design innovative products targeted at providing a high-quality user experience which increases customer satisfaction.
Research funded projects are often concerned with the development of proof-of-concept products. Consequently, activities related to verification and validation testing (VVT) are often not considered in depth, even though various design iterations are carried out to refine an idea. Furthermore, the introduction of additive manufacturing (AM) has facilitated, in particular, the development of bespoke medical products. End bespoke products, which will be used by relevant stakeholders (e.g. patients and clinicians) are fabricated with the same manufacturing technologies used during prototyping. As a result, the detailed design stage of products fabricated by AM is much shorter. Therefore, to improve the market-readiness of bespoke medical devices, testing must be integrated within the development from an early stage, allowing better planning of resources. To address these issues, in this paper, a comprehensive VVT framework is proposed for research projects, which lack a VVT infrastructure. The framework builds up on previous studies and methods utilised in industry to enable project key experts to capture risks as early as the concept design stage.
A significant number of people with autism require in-patient psychiatric care. Although the requirement to adequately meet the needs of people with autism in these settings is enshrined in UK law and supported by national guidelines, little information is available on current practice.
To describe characteristics of UK in-patient psychiatric settings admitting people with autism. Also to examine psychiatric units for their suitability, and the resultant impact on admission length and restrictive interventions.
Multiple-choice questions about in-patient settings and their ability to meet the needs of people with autism and the impact on their outcomes were developed as a cross-sectional study co-designed with a national autism charity. The survey was distributed nationally, using an exponential and non-discriminatory snowballing technique, to in-patient unit clinicians to provide a current practice snapshot.
Eighty responses were analysed after excluding duplications, from across the UK. Significant variation between units across all enquired parameters exist. Lack of autism-related training and skills across staff groups was identified, this becoming disproportionate when comparing intellectual disability units with general mental health units particularly regarding psychiatrists working in these units (psychiatrists: 94% specialist skills in intellectual disability units versus 6% specialist skills in general mental health units). In total, 28% of survey respondents felt people with autism are more likely to be subject to seclusion and 40% believed in-patients with autism are likely to end in segregation.
There is no systematic approach to supporting people with autism who are admitted to in-patient psychiatric units. Significant concerns are highlighted of lack of professional training and skill sets resulting in variable clinical practice and care delivery underpinned by policy deficiency. This could account for the reported in-patient outcomes of longer stay and segregation experienced by people with autism.
Depression and overweight are each associated with abnormal immune system activation. We sought to disentangle the extent to which depressive symptoms and overweight status contributed to increased inflammation and abnormal cortisol levels.
Participants were recruited through the Wellcome Trust NIMA Consortium. The sample of 216 participants consisted of 69 overweight patients with depression; 35 overweight controls; 55 normal-weight patients with depression and 57 normal-weight controls. Peripheral inflammation was measured as high-sensitivity C-Reactive Protein (hsCRP) in serum. Salivary cortisol was collected at multiple points throughout the day to measure cortisol awakening response and diurnal cortisol levels.
Overweight patients with depression had significantly higher hsCRP compared with overweight controls (p = 0.042), normal-weight depressed patients (p < 0.001) and normal-weight controls (p < 0.001), after controlling for age and gender. Multivariable logistic regression showed that comorbid depression and overweight significantly increased the risk of clinically elevated hsCRP levels ⩾3 mg/L (OR 2.44, 1.28–3.94). In a separate multivariable logistic regression model, overweight status contributed most to the risk of having hsCRP levels ⩾3 mg/L (OR 1.52, 0.7–2.41), while depression also contributed a significant risk (OR 1.09, 0.27–2). There were no significant differences between groups in cortisol awakening response and diurnal cortisol levels.
Comorbid depression and overweight status are associated with increased hsCRP, and the coexistence of these conditions amplified the risk of clinically elevated hsCRP levels. Overweight status contributed most to the risk of clinically elevated hsCRP levels, but depression also contributed to a significant risk. We observed no differences in cortisol levels between groups.