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This article explores the use of empathy in historical research. Using evidence collected from a number of academic historians working in UK higher education institutions in 2022, this article uses empathy as a window into historians’ attitudes towards the professional self, the appearance of objectivity and their relationship to the historical subject. It explores the role of empathy in learning history, teaching history, in historical research including the selection of sources, and in the communication of historical research to different audiences. It discusses empathetic historical approaches, suggesting that these can be categorised into three distinct taxonomies: historical empathy, where the researcher engages with the historical subject using professional detachment to manage their affective response; historicised empathy, where the researcher employs deep knowledge of historical context to understand and appreciate the worldview of their historical subject; and empathy as historical approach, so person-centred (rather than system-centred) accounts of history. Finally, this article tests its hypotheses by exploring histories in which empathy is absent.
Catheterisation is the gold standard used to evaluate pulmonary blood flow in patients with a Blalock–Thomas–Taussig shunt. It involves risk and cannot be performed frequently. This study aimed to evaluate if echocardiographic measurements obtained in a clinical setting correlate with catheterisation-derived pulmonary blood flow in patients with a Blalock–Thomas–Taussig shunt as the sole source of pulmonary blood flow.
Chart review was performed retrospectively on consecutive patients referred to the catheterisation lab with a Blalock–Thomas–Taussig shunt. Echocardiographic parameters included peak, mean, and diastolic gradients across the Blalock–Thomas–Taussig shunt and forward and reverse velocity time integral across the distal transverse aorta. In addition to direct correlations, we tested a previously published formula for pulmonary blood flow calculated as velocity time integral across the shunt × heart rate × Blalock–Thomas–Taussig shunt area. Catheterisation parameters included pulmonary and systemic blood flow as calculated by the Fick principle.
18 patients were included. The echocardiography parameters and oxygen saturation did not correlate with catheterisation-derived pulmonary blood flow, systemic blood flow, or the ratio of pulmonary to systemic blood flow. As the ratio of reverse to forward velocity time integral across the transverse aorta increased, the probability of shunt stenosis decreased.
Echocardiographic measurements obtained outside the catheterisation lab do not correlate with catheterisation-derived pulmonary blood flow. The ratio of reverse to forward velocity time integral across the transverse aortic arch may be predictive of Blalock–Thomas–Taussig shunt narrowing; this finding should be investigated further.
Benevolent intersubjectivity developed in parent–infant interactions and compassion toward friend and foe alike are non-violent interventions to group behavior in conflict. Based on a dyadic active inference framework rooted in specific parental brain mechanisms, we suggest that interventions promoting compassion and intersubjectivity can reduce stress, and that compassionate mediation may resolve conflicts.
Current information about the prevalence of various mental health disorders in the general adult population of the Republic of Ireland is lacking. In this study, we examined the prevalence of 12 common mental disorders, the proportion of adults who screened positive for any disorder, the sociodemographic factors associated with meeting criteria for a disorder and the associations between each disorder and history of attempted suicide.
A non-probability nationally representative sample (N = 1110) of adults living in Ireland completed self-report measures of 12 mental health disorders. Effect sizes were calculated using odds ratios from logistic regression models, and population attributable risk fractions (PAFs) were estimated to quantify the associations between each disorder and attempted suicide.
Prevalence rates ranged from 15.0% (insomnia disorder) to 1.7% (histrionic personality disorder). Overall, 42.5% of the sample met criteria for a mental health disorder, and 11.1% had a lifetime history of attempted suicide. Younger age, being a shift worker and trauma exposure were independently associated with a higher likelihood of having a mental health disorder, while being in university was associated with a lower likelihood of having a disorder. ICD-11 complex posttraumatic stress disorder, borderline personality disorder and insomnia disorder had the highest PAFs for attempted suicide.
Mental health disorder prevalence in Ireland is relatively high compared to international estimates. The findings are discussed in relation to important mental health policy implications.
The work in this collection so far has discussed the concept of long-term recovery as having a multitude of meanings for a variety of people with lived experience of substance use. For some, long-term recovery is about ongoing abstinence from specific or all substances; for others, it is about reducing the quantity of substance used or changing the type of substance used. For many, long-term recovery may not be an experience that will ever be found. This current chapter argues that when exploring the concept of long-term recovery from substance use, it is important to acknowledge the role of long-term trauma,1 because substance use is about so much more than the drug itself, it is ‘a response to life experience, not simply to a drug’ (Maté, 2018, p 304).
The idea of long-term recovery from substance use must be contextualised within the long-lasting impact of trauma. Problematic substance use is common among trauma survivors, as are anxiety, PTSD, depression and eating disorders (West and Merritt-Gray, 2001; Lindhorst and Beadnell, 2011; McLaughlin, 2017). Victims of physical and sexual abuse ‘often develop long term reactions that include fear, anxiety, fatigue, sleep and eating disturbances, intense startle reactions, and physical complaints’ (Van Der Kolk, 2014, p 8). Symptoms of trauma may return at different stages of life (when having children, suffering significant personal losses or during new relationships), and a person with past trauma may return to treatment years after she considered herself ‘recovered’ (Herman, 2015). In turn, sudden symptoms of trauma could once again trigger the use of substances if they are used as a coping strategy (Smith, 2019). Moreover, both childhood and adult trauma, particularly experiences of physical and sexual abuse, have been described as an isolating, ‘disconnecting’ experience, removing the feeling of belonging to other people and the community (Herman, 2015). This is the result of spoiled trust, feelings of guilt, shame and inferiority caused by the trauma. As Herman puts it, ‘Traumatic events have primary effects not only on the psychological structures of the self but also on the systems of attachment and meaning that link individual and community’ (Herman, 2015, p 51).
There is strong public belief that polyunsaturated fats protect against and ameliorate depression and anxiety.
To assess effects of increasing omega-3, omega-6 or total polyunsaturated fat on prevention and treatment of depression and anxiety symptoms.
We searched widely (Central, Medline and EMBASE to April 2017, trial registers to September 2016, ongoing trials updated to August 2019), including trials of adults with or without depression or anxiety, randomised to increased omega-3, omega-6 or total polyunsaturated fat for ≥24 weeks, excluding multifactorial interventions. Inclusion, data extraction and risk of bias were assessed independently in duplicate, and authors contacted for further data. We used random-effects meta-analysis, sensitivity analyses, subgrouping and Grading of Recommendations, Assessment, Development and Evaluations (GRADE) assessment.
We included 31 trials assessing effects of long-chain omega-3 (n = 41 470), one of alpha-linolenic acid (n = 4837), one of total polyunsaturated fat (n = 4997) and none of omega-6. Meta-analysis suggested that increasing long-chain omega-3 probably has little or no effect on risk of depression symptoms (risk ratio 1.01, 95% CI 0.92–1.10, I2 = 0%, median dose 0.95 g/d, duration 12 months) or anxiety symptoms (standardised mean difference 0.15, 95% CI 0.05–0.26, I2 = 0%, median dose 1.1 g/d, duration 6 months; both moderate-quality evidence). Evidence of effects on depression severity and remission in existing depression were unclear (very-low-quality evidence). Results did not differ by risk of bias, omega-3 dose, duration or nutrients replaced. Increasing alpha-linolenic acid by 2 g/d may increase risk of depression symptoms very slightly over 40 months (number needed to harm, 1000).
Long-chain omega-3 supplementation probably has little or no effect in preventing depression or anxiety symptoms.
Declaration of interest
L.H. and A.A. were funded to attend the World Health Organization Nutrition Guidance Expert Advisory Group (NUGAG) Subgroup on Diet and Health meetings and present review results. The authors report no other conflicts of interest.
Contaminated hands of healthcare workers (HCWs) are an important source of transmission of healthcare-associated infections. Alcohol-based hand sanitizers, while effective, do not provide sustained antimicrobial activity. The objective of this study was to compare the immediate and persistent activity of 2 hand hygiene products (ethanol [61% w/v] plus chlorhexidine gluconate [CHG; 1.0% solution] and ethanol only [70% v/v]) when used in an intensive care unit (ICU).
Prospective, randomized, double-blinded, crossover study
Three ICUs at a large teaching hospital
In total, 51 HCWs involved in direct patient care were enrolled in and completed the study.
All HCWs were randomized 1:1 to either product. Hand prints were obtained immediately after the product was applied and again after spending 4–7 minutes in the ICU common areas prior to entering a patient room or leaving the area. The numbers of aerobic colony-forming units (CFU) were compared for the 2 groups after log transformation. Each participant tested the alternative product after a 3-day washout period.
On bare hands, use of ethanol plus CHG was associated with significantly lower recovery of aerobic CFU, both immediately after use (0.27 ± 0.05 and 0.88 ± 0.08 log10 CFU; P = .035) and after spending time in ICU common areas (1.81 ± 0.07 and 2.17 ± 0.05 log10 CFU; P<.0001). Both the antiseptics were well tolerated by HCWs.
In comparison to the ethanol-only product, the ethanol plus CHG sanitizer was associated with significantly lower aerobic bacterial counts on hands of HCWs, both immediately after use and after spending time in ICU common areas.
Macrophages are a major leukocyte involved in orchestrating inflammatory responses. Their name is derived from the Greek term “big eaters” (makros, large; and phagein, eat). This gives some insight into the primary function of this cell in clearance of invading pathogens, cell debris, and apoptotic cells by a process of engulfment and digestion called “phagocytosis.” However, the role of the macrophage goes beyond that of what its name suggests. They are endowed with the ability to rapidly react to and secrete a plethora of biological agents and mediators that can influence the initiation, progression, and resolution of an inflammatory response and coordinate processes to establish acquired immunity against specific pathogens. This chapter is an overview of the basics of macrophage biology and function, with particular insights into the involvement of macrophages in disease pathogenesis as well as pharmacological modulation of macrophage responses as targets for treatment of disease.
Elie Metchnikoff first used the term “macrophage” to describe large mononuclear phagocytic cells he observed in tissues over 100 years ago. Macrophages are now recognized as the major phagocytic cell type with diverse characteristics and localities around the body where they are important for both innate and acquired immune responses as well as maintenance of tissue homeostasis and regulation of various processes subsidiary to the immune defense such as hematopoiesis.
In addition to deficits in delayed recall, recent research suggests that participants with amnestic mild cognitive impairment (aMCI) demonstrate diminished use of strategic encoding strategies during learning. Few studies have explored the cognitive mechanisms underlying this deficit. The aim of this study was to investigate in aMCI whether components of working memory (executive attention – attention set-shifting, dividing and focusing attention; and episodic buffer functions – strategic retrieval and manipulation of information) predict strategic encoding strategies during learning (semantic clustering). Thirty-three participants with aMCI and 33 healthy older adults (HOA) were administered neuropsychological tests assessing word-list learning and working memory. The aMCI group demonstrated significant impairment in acquisition, retrieval of information, and decreased use of semantic clustering strategies. Use of semantic clustering in the aMCI group was not predicted by measures of executive attention or phonemic verbal fluency, but was predicted by semantic verbal fluency performance. In the HOA group, semantic clustering was strongly related to semantic verbal fluency. These findings suggest that in aMCI, diminished strategic encoding strategies during learning (semantic clustering) is selectively related to the strategic function of the episodic buffer, but only when in interaction with the manipulation and retrieval of semantic associations. (JINS, 2010, 16, 342–351.)
This article reviews milestones in the technological development of mammography since 1970. Mammography is particularly underutilized as a screening procedure for breast cancer and the reasons for its continued inappropriate and under use are explored. Although there are some known barriers to increased utilization among the female adult population, the majority of barriers reside within the domain of referring physicians. Remedies to address the low referral rates for screening mammography are outlined for federal agencies, radiology groups, mammography equipment companies, medical schools, and philanthropic groups. Until the developers of technological procedures such as mammography appreciate that the application of a technology and its appropriate utilization by professionals and the public are important to consider when the technology is developed, utilization rates may not do justice to the technology's potential.