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The aim was to examine the reasons for advice requests by carers of people who live with dementia (PLWD) that attend the Me2u dementia day centre in order to identify key explanatory themes. We hypothesised that requests were related mainly to coordinating care and clinical issues due to limited post-diagnostic support (PDS) in our area.
The Me2u dementia day centre (Merseyside) cares for PLWD and also supports carers. As part of the service, a 24-hour advice line is included for PLWD and their carers who attend the centre. Locally, there is limited PDS and most carers navigate the health and social care system alone mirroring the findings by the National Collaborating Centre for Mental Health (NCCMH).
We undertook a retrospective evaluation of 244 advice calls, from 64 carers, between 01/06/2019 and 31/12/2019. We analysed time of call, type of advice, type of dementia, age and whether the advice was for the PLWD or for the carer.
Of the 244 calls, the most common time to call was between 09.00 - 14.00 (n = 168; (68.8%) peak 09.00 - 10.00 (n = 38). Average age of the person about whom the advice was sought was 79.08 years. 91.4% of the advice calls related to PLWD (most common dementia Alzheimer's) and 8.6% to the carer only. The mean number of calls per person was 3.8 (range 1–24).
Advice data were grouped into 9 broad themes namely, related to symptoms/behaviour (32.79%, n = 80), request for Me2u to coordinate care (20.08%, n = 49), general advice (14.75%, n = 36), personal care (9.42%, n = 23), carer only advice (8.60%, n = 21), social issues (6.14%, n = 15), social care (4.50%, n = 11), safeguarding (2.46%, n = 6), non-health and social care issue (1.23%, n = 3).
Reasons for limited/poor PDS given by the NCCMH are; absence of named coordinators of care, over-reliance on families and carers to manage and facilitate appointments, poor recognition and management of comorbidities. This data show that 52.87% of calls were for clinical advice and coordination of care reflecting NCCMH findings. The interventions post-call reduced the impact on providers of urgent care.
These findings provide support for the provision of a [24-hour] advice line as a routine part of post-diagnostic support services, especially in areas that have limited or poor PDS. Commissioners of PDS services in areas that have limited or poor PDS should make this a priority to prevent unplanned admissions to hospital and carer breakdown.
This article critically re-assesses Conor Cruise O'Brien's attitude to Northern Ireland between 1969 and 1977. It argues that O'Brien's most significant contribution to public life was the ability to deconstruct many aspects of Irish nationalism, specifically his rejection of the Irish state's irredentist claim over Northern Ireland. In doing so, it contends that O'Brien was one of the most important, and outspoken, champions of so-called ‘revisionist nationalism’ of his generation. The article examines three themes in relation to O'Brien's attitude to Northern Ireland: his attack on the Irish state's anti-partitionism; his rejection of Irish republican terrorism; and his support for the ‘principle of consent’ argument. The article illustrates that O'Brien was criticised in nationalist circles and accused of committing political heresy. Indeed, his willingness to challenge the attitude of most mainstream Irish politicians on Northern Ireland invariably left him an isolated figure, even among his own Labour Party comrades. Writing in his Memoir, O'Brien neatly summed up the difficult position in which he found himself: ‘I was altogether out of tune with my colleagues over Northern Ireland’.
A proposition which emanates from myself – whether cited variously as my eulogy or as blame – I claim it as my own together with all those that crowd in here – affirms, in short, that everything in the world exists in order to end up as a book. (Stéphane Mallarmé)
Commentary on a text which does not exist
Of course it would be in the Campo de’ Fiori that I should find at last a copy of a text I had long sought. The sellers of chemically produced truffle oils, dubious balsamic vinegars and other fake delicacies were packing up while the last of the old nonnas boxed unsold vegetables into the precarious moto-vans in which they’d brought them from their dusty farms or allotments outside the city. Rome's street sweepers are bested only by their Neapolitan confreres in indifference to the actual business of cleaning, so the trash of the morning market fluttered around the legs of stalls in the process of being disassembled, as the sweepers stood gossiping listlessly or chewing on slices of pizza bianca from the Forno in the corner of the square. Tourists wandered off, doubting their overpriced purchases, or discovered the square for the first time, staring in knowledge or ignorance at the forbidding statue of Giordano Bruno, who dreamed of an object of radiant textuality – a certain circular Book, whose circumference is everywhere and centre, nowhere – and who perhaps, at last, had sighted it, as he was burned to death here by the Roman Inquisition on Ash Wednesday 1600. With a bar through his tongue, his vision of a universe turned upside down was at last substantiated.
In one corner of the piazza, appropriately, there is a bookshop called Fahrenheit 451. Like most of Rome's booksellers, the proprietor gives the impression that his customers are an inconvenience, and doubtless they are, here in Campo de’ Fiori, where tourists occasionally wander accidentally into the shop and leave, bemused, because all the books are, inevitably, in Italian. But bookshops are sacred, regardless of language, and so I found myself browsing the tables in the pleasingly gloomy front room, before scanning the shelves in a narrow corridor leading into further, gloomier rooms at the rear of the shop.
Cognitive screening is an efficient method of detecting cognitive impairment in adults and may signal need for comprehensive assessment. Cognitive screening is not, however, routinely used in youth aged 12–25, limiting clinical recommendations. The aims of this review were to describe performance-based cognitive screening tools used in people aged 12–25 and the contexts of use, review screening accuracy in detecting cognitive impairment relative to an objective reference standard, and evaluate the risk of bias of included studies.
Electronic databases (Scopus, Medline, PsychINFO, and ERIC) were searched for relevant studies according to pre-determined criteria. Risk of bias was rated using the Quality Assessment of Diagnostic Accuracy Studies-2. Dual screening, extraction, and quality ratings occurred at each review phase.
Twenty studies met the review inclusion criteria. A diverse range of screening tools (length, format) were used in youth aged 12–25 with or without health conditions. Six studies investigating cognitive screening were conducted as primary accuracy studies and reported some relevant psychometric parameters (e.g., sensitivity and specificity). Fourteen studies presented correlational data to investigate the cognitive measure utility. Studies generally presented limited data on classification accuracy, which impacted full screening tool appraisal. Risk of bias was high (or unclear) in most studies with poor adherence to the Standards for Reporting Diagnostic Accuracy Studies (STARD) criteria.
Few, high quality studies have investigated the utility of cognitive screening in youth aged 12–25, with no screening measure emerging as superior at detecting cognitive impairment in this age group.
Ainslie's account of willpower is conspicuously individualistic. Because other people, social influence, and culture appear only peripherally, it risks overlooking what may be resolve's deeply social roots. We identify a general “outside-in” explanatory strategy suggested by a range of recent research into human cognitive evolution, and suggest how it might illuminate the origins and more social aspects of resolve.
This study provides a morphological and phylogenetic characterization of two novel species of the order Haplosporida (Haplosporidium carcini n. sp., and H. cranc n. sp.) infecting the common shore crab Carcinus maenas collected at one location in Swansea Bay, South Wales, UK. Both parasites were observed in the haemolymph, gills and hepatopancreas. The prevalence of clinical infections (i.e. parasites seen directly in fresh haemolymph preparations) was low, at ~1%, whereas subclinical levels, detected by polymerase chain reaction, were slightly higher at ~2%. Although no spores were found in any of the infected crabs examined histologically (n = 334), the morphology of monokaryotic and dikaryotic unicellular stages of the parasites enabled differentiation between the two new species. Phylogenetic analyses of the new species based on the small subunit (SSU) rDNA gene placed H. cranc in a clade of otherwise uncharacterized environmental sequences from marine samples, and H. carcini in a clade with other crustacean-associated lineages.
The Apolipoprotein (APOE) ε4 allele increases the risk for mild cognitive impairment (MCI) and dementia, but not all carriers develop MCI/dementia. The purpose of this exploratory study was to determine if early and subtle preclinical signs of cognitive dysfunction and medial temporal lobe atrophy are observed in cognitively intact ε4 carriers who subsequently develop MCI.
Twenty-nine healthy, cognitively intact ε4 carriers (ε3/ε4 heterozygotes; ages 65–85) underwent neuropsychological testing and MRI-based measurements of medial temporal volumes over a 5-year follow-up interval; data were converted to z-scores based on a non-carrier group consisting of 17 ε3/ε3 homozygotes.
At follow-up, 11 ε4 carriers (38%) converted to a diagnosis of MCI. At study entry, the MCI converters had significantly lower scores on the Mini-Mental State Examination, Rey Auditory Verbal Learning Test (RAVLT) Trials 1–5, and RAVLT Immediate Recall compared to non-converters. MCI converters also had smaller MRI volumes in the left subiculum than non-converters. Follow-up logistic regressions revealed that left subiculum volumes and RAVLT Trials 1–5 scores were significant predictors of MCI conversion.
Results from this exploratory study suggest that ε4 carriers who convert to MCI exhibit subtle cognitive and volumetric differences years prior to diagnosis.
Despite knowing for many decades that depressive psychopathology is common in first-episode schizophrenia spectrum disorders (FES), there is limited knowledge regarding the extent and nature of such psychopathology (degree of comorbidity, caseness, severity) and its demographic, clinical, functional and treatment correlates. This study aimed to determine the pooled prevalence of depressive disorder and caseness, and the pooled mean severity of depressive symptoms, as well as the demographic, illness, functional and treatment correlates of depressive psychopathology in FES.
This systematic review, meta-analysis and meta-regression was prospectively registered (CRD42018084856) and conducted in accordance with PRISMA and MOOSE guidelines.
Forty studies comprising 4041 participants were included. The pooled prevalence of depressive disorder and caseness was 26.0% (seven samples, N = 855, 95% CI 22.1–30.3) and 43.9% (11 samples, N = 1312, 95% CI 30.3–58.4), respectively. The pooled mean percentage of maximum depressive symptom severity was 25.1 (38 samples, N = 3180, 95% CI 21.49–28.68). Correlates of depressive psychopathology were also found.
At least one-quarter of individuals with FES will experience, and therefore require treatment for, a full-threshold depressive disorder. Nearly half will experience levels of depressive symptoms that are severe enough to warrant diagnostic investigation and therefore clinical intervention – regardless of whether they actually fulfil diagnostic criteria for a depressive disorder. Depressive psychopathology is prominent in FES, manifesting not only as superimposed comorbidity, but also as an inextricable symptom domain.
This essay assesses the challenge of digital culture to the representation and reproduction of Chaucer’s work, arguing that scholarly projects associated with the emergence of ‘digital humanities’ have in the main replicated the humanist goals of traditional literary scholarship. With the rapidly changing nature of digital textualities, the essay concludes by suggesting that a proper reckoning between Chaucer’s works and digital culture has yet to take place.